Serin Kürşat Rahmi, Keskin Metin, Bakkaloğlu Hüseyin, Tunca Fatih, Aydın Ali Emin, Eldegez Cumhur Uluğ
Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
Ulus Travma Acil Cerrahi Derg. 2013 Jan;19(1):65-8. doi: 10.5505/tjtes.2013.53496.
Gastrointestinal complications such as gastrointestinal bleeding and perforation due to immunosuppressant use are seen more frequently after solid organ transplantation. A 52-year-old male was admitted on the 7th day of a living donor renal transplantation with serous drainage at the incision site. He had no abdominal complaints. He was on triple immunosuppressant therapy. Abdominal plain X-ray and ultrasonography were normal, but diffuse extraluminal air was detected on the computed tomography scan. There were no pathological laboratory findings regarding the function of the renal allograft. We began the operation laparoscopically and then converted to laparotomy. Sigmoid colonic perforation was detected on the antimesenteric side. Neither diverticulitis nor ischemia was observed, and no evidence of iatrogenic injury was seen. There was no transrectal instrumentation history. Omentoplasty and sigmoid loop colostomy were performed. He was discharged on the 9th day following the operation. His colostomy was closed one year after the operation. Gastrointestinal complications can be fatal, but do not seem to influence the long-term survival or renal allograft function. Most of them are seen after using high doses of immunosuppressants to manage the early postoperative period or episodes of acute rejection. Early diagnosis and aggressive treatment play an important role in survival.
实体器官移植后，因使用免疫抑制剂而出现的胃肠道并发症，如胃肠道出血和穿孔更为常见。一名52岁男性在活体供肾移植术后第7天因切口处有浆液性引流物入院。他没有腹部不适。他正在接受三联免疫抑制治疗。腹部平片和超声检查正常，但计算机断层扫描发现弥漫性腔外气体。关于同种异体肾移植功能，实验室检查没有病理结果。我们首先进行腹腔镜手术，然后转为开腹手术。在乙状结肠系膜对侧发现穿孔。未观察到憩室炎或缺血，也未见医源性损伤迹象。没有经直肠器械操作史。进行了网膜成形术和乙状结肠袢式造口术。他在术后第9天出院。术后一年关闭了他的结肠造口。胃肠道并发症可能是致命的，但似乎不影响长期生存或同种异体肾移植功能。大多数并发症出现在使用高剂量免疫抑制剂处理术后早期或急性排斥反应发作时。早期诊断和积极治疗对生存起着重要作用。
