Miura Yuichi, Sato Kazushige, Kawagishi Naoki, Ohuchi Noriaki
Advanced Surgical Science and Technology Division, Department of Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan.
Exp Clin Transplant. 2015 Jun;13(3):295-7. doi: 10.6002/ect.2014.0018. Epub 2014 Jul 31.
Strangulated small bowel obstruction is a complication after abdominal surgery, which is rare in renal transplant patients. A 61-year-old man with a strangulated small bowel obstruction underwent renal transplant surgery 7 years before the current admission. He was admitted to our hospital for abdominal pain, nausea, and abdominal distention. An abdominal computed tomography and an ultrasound examination showed intestinal expansion and fluid collection without ascites. His disease was diagnosed as a small bowel obstruction and conservative treatment was begun. However, because of increasing abdominal pain and the collection of ascites, he underwent an emergency laparotomy and was diagnosed as having a strangulated small bowel obstruction. A fibrous cord had formed between the peritoneum (beside the transplanted kidney) and the root of the sigmoid mesocolon, strangulating the looped ileum and causing bleeding necrosis and hemorrhagic ascites collection. The cord and the necrotic ileum were resected, followed by an end-to-end anastomosis. He was discharged 17 days after the surgery in good condition. This is the first reported case of a person having a strangulated small bowel obstruction by a fibrous cord, who did not have a history of laparotomy after renal transplant. A strangulated small bowel obstruction after a renal transplant in a patient with no history of a laparotomy is a rare, but possible postoperative complications should be considered when making a differential diagnosis.
绞窄性小肠梗阻是腹部手术后的一种并发症，在肾移植患者中较为罕见。一名61岁患有绞窄性小肠梗阻的男性在本次入院前7年接受了肾移植手术。他因腹痛、恶心和腹胀入院。腹部计算机断层扫描和超声检查显示肠道扩张并有积液，但无腹水。他的疾病被诊断为小肠梗阻，并开始进行保守治疗。然而，由于腹痛加剧和腹水形成，他接受了急诊剖腹手术，被诊断为绞窄性小肠梗阻。在腹膜（移植肾旁）和乙状结肠系膜根部之间形成了一条纤维索带，压迫回肠袢，导致出血坏死和血性腹水形成。切除纤维索带和坏死的回肠，然后进行端端吻合。术后17天他康复出院，身体状况良好。这是首例报道的肾移植后无剖腹手术史的患者因纤维索带导致绞窄性小肠梗阻的病例。肾移植后无剖腹手术史的患者发生绞窄性小肠梗阻虽罕见，但在进行鉴别诊断时应考虑到这种可能的术后并发症。
