Organ Transplantation Department, The First People's Hospital of Changde City, Changde, China.
Medicine (Baltimore). 2023 Feb 3;102(5):e32836. doi: 10.1097/MD.0000000000032836.
Abdominal infection combined with pneumoperitoneum after renal transplantation is rare, clinically confusing, and easily misdiagnosed by physicians as gastrointestinal perforation.
A 54-year-old man experienced abdominal pain and distension together with signs of peritoneal irritation after cadaveric renal transplantation. CT and standing abdominal plain film showed a large pneumoperitoneum in the abdominal cavity and the patient underwent an exploratory laparotomy but no gastrointestinal perforation was found.
No gastrointestinal perforation was found during the operation. In the search for the infectious agent, ascites culture was negative while next-generation sequencing was positive, suggesting the presence of intestinal flora ectopic to abdominal infection with anaerobic respiration fermentation leading to large amounts of gas.
The patient underwent exploratory laparotomy without gastrointestinal perforation, and then underwent abdominal lavage, placed abdominal drainage tube, and conducted culture and next-generation sequencing examination of ascites.
Postoperative symptoms were relieved and intestinal function recovered. After 3 months of outpatient follow-up, the patient had stable transplanted kidney function and was in good spirits and sleeping well, with a good appetite, soft and regular stools, no abdominal pain and distension, and no fever.
Patients after kidney transplantation should be wary of abdominal infection being misdiagnosed as gastrointestinal perforation.
肾移植后合并气腹的腹部感染较为罕见，临床表现复杂，易被临床医生误诊为胃肠道穿孔。
一名 54 岁男性在尸体肾移植后出现腹痛和腹胀，并伴有腹膜刺激征。CT 和立位腹部平片显示腹腔内大量气腹，患者行剖腹探查术，但未发现胃肠道穿孔。
术中未发现胃肠道穿孔。在寻找感染源时，腹水培养阴性，而下一代测序阳性，提示存在肠道菌群异位至腹部感染，进行无氧呼吸发酵导致大量气体产生。
患者行剖腹探查术，未发现胃肠道穿孔，行腹腔冲洗，放置腹腔引流管，并对腹水进行培养和下一代测序检查。
术后症状缓解，肠功能恢复。门诊随访 3 个月后，患者移植肾功能稳定，精神状态良好，睡眠良好，食欲良好，大便柔软、规律，无腹痛、腹胀，无发热。
肾移植术后患者应警惕将腹部感染误诊为胃肠道穿孔。
