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Syndrome of multiple bowel perforations in liver transplant recipients
W C Marujo1, R J Stratta, A N Langnas
1Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280.
Insights
Pediatric liver transplant patients can develop multiple bowel perforations unrelated to surgical injury. Aggressive surgical management, including frequent explorations, leads to excellent outcomes in these rare cases.
Area of Science:
- Gastroenterology
- Transplant Surgery
- Pediatric Surgery
Background:
- Orthotopic liver transplantation is a complex procedure with potential surgical complications.
- Multiple bowel perforations, not caused by surgical error, are a rare but serious complication observed post-transplant.
Purpose of the Study:
- To analyze the incidence, characteristics, and management outcomes of multiple bowel perforations following pediatric orthotopic liver transplantation.
- To investigate potential etiologies and identify effective treatment strategies for this specific complication.
Main Methods:
- Retrospective analysis of 500 consecutive orthotopic liver transplants.
- Identification and detailed review of 12 pediatric patients diagnosed with multiple bowel perforations.
- Evaluation of intraoperative findings, management strategies, and patient follow-up data.
Main Results:
- Twelve pediatric patients (mean weight 9.0 kg) developed multiple bowel perforations, representing 7% of the pediatric transplant population.
- Perforations were typically pin-point and found in normal-appearing bowel, with no clear etiology in most cases.
- All 12 patients survived with a mean follow-up of 34.9 months following aggressive surgical intervention.
Conclusions:
- Multiple bowel perforations post-pediatric liver transplant is a distinct syndrome with unclear pathogenesis, possibly linked to high-dose steroids.
- Aggressive surgical management, including semiopen peritonitis treatment and frequent re-explorations, is effective in achieving positive outcomes.
Abstract:
In an analysis of surgical complications following 500 consecutive orthotopic liver transplants, we identified 12 patients who developed the syndrome of multiple bowel perforations that was not due to iatrogenic injury. All cases occurred in small children (mean weight: 9.0 kg), who represented 7% of the pediatric population. Each patient had a minimum of three perforations. The typical intraoperative findings were pin-point perforations in areas of normal-appearing bowel. With only one possible exception (a patient with cytomegalovirus enteritis), no specific etiology could be determined. Management was based on multiple exploratory laparotomies and individualized operative procedures. All patients are currently alive (mean follow-up: 34.9 months). The pathogenesis of the syndrome of multiple bowel perforations remains unclear but is possibly multifactorial or related to high doses of steroids. Aggressive surgical management with semiopen treatment of peritonitis and frequent explorations has afforded excellent results.