Recurrent complicated colon diverticulitis in renal transplanted patient

Area of Science:

• Gastroenterology
• Nephrology
• Transplantation immunology

Background:

• Diverticulitis poses a severe risk post-kidney transplantation, complicated by diagnostic challenges in immunocompromised patients.
• This case involves a kidney transplant recipient with a history of diverticulosis presenting with recurrent diverticulitis.

Observation:

• The patient experienced two distinct episodes of complicated diverticulitis, initially presenting as a pelvic abscess (Hinchey-I) and later as a larger abscess involving the transverse colon and small intestine (Hinchey-II).
• Initial management involved a Hartmann procedure for the first episode, followed by intestinal continuity restoration.
• The second episode required segmental resection of the colon, jejunum, and ileum.

Findings:

• The study demonstrates that immunocompromised kidney transplant recipients can experience recurrent episodes of complicated diverticulitis.
• Despite the complexity, surgical interventions including Hartmann procedure and segmental resection were successfully performed.
• Primary anastomosis was considered feasible for localized peritonitis in complicated diverticulitis.

Implications:

• Early and accurate diagnosis of diverticulitis is crucial in immunocompromised transplant patients.
• Recurrent diverticulitis necessitates careful surgical planning and management.
• This case suggests primary anastomosis may be a safe and effective option for selected cases of complicated diverticulitis in this patient population.