Tantisattamo Ekamol, Guasch Antonio
Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322 , USA.
Hawaii J Med Public Health. 2013 Jul;72(7):216-8.
Perforated sigmoid diverticulitis, a complication of colonic diverticulosis commonly associated with autosomal dominant polycystic kidney disease (ADPKD), can be life-threatening in allogeneic kidney transplant recipients in the postoperative period. Immunosuppressive medications not only place the patient at risk for intestinal perforation, but also mask classic clinical symptoms and signs of acute abdomen, and subsequently lead to delayed diagnosis and treatment. We report a case of an ADPKD patient post kidney transplantation presenting with nausea, vomiting, and abdominal pain without signs of peritonitis. Chest x-ray revealed free air under the diaphragm consistent with intestinal perforation. Post kidney transplant recipients with ADPKD presenting with abdominal pain should prompt a search for possible perforated colonic diverticulitis in order to diagnose and treat this life-threatening condition early.
乙状结肠憩室炎穿孔是结肠憩室病的一种并发症，通常与常染色体显性多囊肾病（ADPKD）相关，在同种异体肾移植受者术后可危及生命。免疫抑制药物不仅使患者面临肠穿孔风险，还会掩盖急性腹痛的典型临床症状和体征，进而导致诊断和治疗延误。我们报告一例肾移植术后的ADPKD患者，出现恶心、呕吐和腹痛，但无腹膜炎体征。胸部X线显示膈下游离气体，符合肠穿孔表现。肾移植术后出现腹痛的ADPKD患者应警惕可能的结肠憩室炎穿孔，以便早期诊断和治疗这种危及生命的疾病。
