Rahnemai-Azar A A, Penna M, Morrison S D, Rayhill S C, Sibulesky L, Muczynski K A, Bakthavatsalam R
Department of Surgery, University of Washington Medical Center, University of Washington, Seattle, Washington.
Department of Medicine, University of Washington Medical Center, University of Washington, Seattle, Washington.
Transplant Proc. 2017 Oct;49(8):1960-1962. doi: 10.1016/j.transproceed.2017.04.009.
Complicated diverticulitis after transplantation occurs in as many as 3.5% of cases and carries a 25% mortality rate. Diagnosis of complicated diverticulitis in this population can be challenging because of abnormal presentations caused by immunosuppression. Only 4 cases of fistulization after kidney transplantation are described in the literature; none occurred after simultaneous pancreas-kidney transplant.
We present a first case of a coloduodenovesical fistula in a patient 9 years after simultaneous pancreas-kidney transplant. The patient presented with intermittent episodes of elevated creatinine and recurrent urinary tract infection. The presence of fistula was strongly suspected in cystoscopy, but, despite extensive investigation, a fistula tract could not be identified.
The patient ultimately underwent surgical exploration for positive cystoscopy examination, continuation of urinary complaints, and presence of multiple colonic diverticula in computed tomography scan. At surgical exploration, a fistula track was identified between the sigmoid colon and duodenal stump of the pancreas allograft. Subsequently, sigmoidectomy, bladder repair, and enteric conversion of the pancreas transplant were performed.
Complications of diverticulitis should be considered in organ transplant recipients presenting with recurrent urinary infection and elevated creatinine, and surgical exploration might be indicated even if unable to well-define the fistula tract.
移植后复杂性憩室炎的发生率高达3.5%，死亡率为25%。由于免疫抑制导致的异常表现，在该人群中诊断复杂性憩室炎具有挑战性。文献中仅描述了4例肾移植后发生瘘管形成的病例；胰肾联合移植后均未发生。
我们报告了首例胰肾联合移植9年后发生结肠十二指肠膀胱瘘的病例。患者表现为肌酐间歇性升高和反复尿路感染。膀胱镜检查强烈怀疑存在瘘管，但尽管进行了广泛检查，仍未发现瘘管通道。
由于膀胱镜检查阳性、泌尿系统症状持续存在以及计算机断层扫描显示存在多个结肠憩室，患者最终接受了手术探查。手术探查时，在乙状结肠与移植胰腺的十二指肠残端之间发现了一个瘘管通道。随后，进行了乙状结肠切除术、膀胱修复术以及胰腺移植的肠道改道。
对于出现反复尿路感染和肌酐升高的器官移植受者，应考虑憩室炎并发症，即使无法明确瘘管通道，也可能需要进行手术探查。
Zotero 插件