Related Experiment Videos
Intestinal obstruction after lung transplantation in children with cystic fibrosis
R K Minkes1, J C Langer, M A Skinner
1Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
Insights
Intestinal obstruction is common after lung transplantation in cystic fibrosis patients, with prior abdominal surgery being a key risk factor. Preventive measures like bowel preparation may reduce obstruction rates.
Area of Science:
- Gastroenterology
- Pulmonary Medicine
- Transplant Surgery
Background:
- Distal intestinal obstruction syndrome (DIOS) affects 15% of cystic fibrosis (CF) patients.
- Lung transplantation in CF patients carries a risk of intestinal obstruction.
- This study investigates adhesive intestinal obstruction and DIOS post-lung transplant.
Observation:
- 70 CF patients underwent 83 bilateral lung transplants.
- 80% had prior gastrostomy or jejunostomy.
- 25.7% had a history of laparotomy for various conditions, including meconium ileus.
Findings:
- 10% of patients experienced bowel obstruction post-transplant.
- Previous major abdominal surgery significantly increased obstruction risk (39% vs. 0%).
- Adhesions and DIOS were the primary causes, with a high rate of recurrence.
Implications:
- Intestinal obstruction is a significant complication following lung transplantation in CF.
- History of laparotomy is a critical risk factor for post-transplant obstruction.
- Pretransplant bowel preparation and early postoperative lavage may mitigate obstruction risk.
Background/Purpose:
Distal intestinal obstruction syndrome (DIOS) occurs in 15% of patients with cystic fibrosis (CF). The authors reviewed their experience to determine the incidence, risk factors, and natural history of adhesive intestinal obstruction and DIOS after lung transplantation.
Methods:
Eighty-three bilateral transplants were performed in 70 CF patients between January 1990 and September 1998. All were on pancreatic enzymes preoperatively, and none had preoperative bowel preparation. Fifty-six patients (80%) had prior gastrostomy (n = 54) or jejunostomy (n = 2). Eighteen patients (25.7%) had a previous laparotomy for meconium ileus (n = 8), fundoplication (n = 4), liver transplant (n = 1), jejunal atresia (n = 1), Janeway gastrostomy takedown (n = 1), pyloromyotomy (n = 1), free air (n = 1), or appendectomy (n = 1).
Results:
After lung transplantation, 7 patients (10%) required laparotomy for bowel obstruction (6 during the same hospitalization, and 1 during a subsequent hospitalization). The causes of obstruction were adhesions only (n = 1), DIOS only (n = 2), and a combination of DIOS and adhesions (n = 4). Adhesiolysis was performed in the 5 patients with adhesions, and a small bowel resection was also performed in 1 patient. DIOS was treated by milking secretions distally without an enterotomy (n = 3) with an enterotomy and primary closure (n = 1) or with an end ileostomy and mucus fistula (n = 2). Five had recurrent DIOS early postoperatively. One resolved with intestinal lavage, 2 were treated successfully with hypaque disimpaction, and 2 underwent reoperation; 1 required an ileostomy. The most important risk factor for posttransplant obstruction was a previous major abdominal operation. Obstruction occurred in 7 of 18 (39%) who had undergone a prior laparotomy versus 0 of 52 who had not (P < .001, chi2).
Conclusions:
(1) The incidence of intestinal obstruction is high after lung transplantation in children with CF. (2) Previous laparotomy is a significant risk factor. (3) Recurrent obstruction after surgery for this condition is common. (4) Preventive measures such as pretransplant bowel preparation and early postoperative bowel lavage may be beneficial in these patients.