Kristek Jakub, Kudla Michal, Chlupac Jaroslav, Novotny Robert, Mirejovsky Tomas, Janousek Libor, Fronek Jiri
Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague 140 21, Czech Republic
Department of Anatomy, Second Faculty of Medicine, Charles University, Prague 150 06, Czech Republic
World J Clin Cases. 2019 Dec 26;7(24):4270-4276. doi: 10.12998/wjcc.v7.i24.4270.
Acute appendicitis in a solid organ transplant recipient is a rare occurrence, and experience remains limited. Appendicitis in uterine transplant recipients has never been reported. Immunocompromised patients with acute abdomen often present late and with attenuated symptoms. The differential diagnosis in a transplanted patient is broad and challenging due to possible existing complications associated with the graft, effects of immunosuppression, and altered anatomical relations.
A 26-year-old woman suffering from absolute uterine factor infertility received a uterus transplant. In the post-transplant period, she suffered from leukopenia and recurrent acute cellular rejection. Her compliance was suboptimal. She travelled to an exotic destination despite the physician's recommendation not to do so. Following her vacation, she presented with abdominal discomfort, nausea and diarrhoea. There was no sign of acute abdomen; the abdominal ultrasound was negative on day 0. colitis was verified and treated with perorally administered vancomycin. On day 4, the discomfort changed to pain; the ultrasound scan revealed a finding suggestive of appendicitis. Surgical exploration revealed perforated appendicitis, and appendectomy was performed. From a surgical point of view, the patient's follow-up was uneventful. The patient underwent a successful embryo transfer 6 months after the appendectomy. The patient gave birth to a healthy boy at the 35 week of gestation.
A high index of suspicion of an atypical course and symptomatology of acute abdomen should be maintained in immunosuppressed patients.
实体器官移植受者发生急性阑尾炎较为罕见，相关经验有限。子宫移植受者发生阑尾炎的情况此前从未有过报道。免疫功能低下的急腹症患者通常就诊较晚且症状较轻。由于移植相关并发症、免疫抑制作用以及解剖关系改变等潜在因素，移植患者的鉴别诊断范围广泛且具有挑战性。
一名26岁因绝对子宫因素不孕的女性接受了子宫移植。移植后，她出现白细胞减少和反复急性细胞排斥反应。她的依从性欠佳。尽管医生建议不要前往，但她还是前往了一个异国他乡。度假归来后，她出现腹部不适、恶心和腹泻。无急腹症体征；第0天腹部超声检查结果为阴性。确诊为结肠炎并口服万古霉素进行治疗。第4天，不适转变为疼痛；超声检查显示有提示阑尾炎的表现。手术探查发现阑尾穿孔，遂行阑尾切除术。从手术角度来看，患者的后续恢复过程顺利。阑尾切除术后6个月，患者成功进行了胚胎移植。患者在妊娠35周时产下一名健康男婴。
对于免疫抑制患者，应高度怀疑急性腹痛的非典型病程和症状表现。
