Double Obstruction Following Third Renal Transplant: A Case Report

Area of Science:

• Nephrology
• Transplant Surgery
• Gastroenterology

Background:

• Kidney allografts have limited lifespans, increasing the need for renal retransplantation.
• While graft and patient survival are comparable to first-time transplants, retransplants, especially third or subsequent ones, carry distinct surgical risks.
• The retroperitoneal placement in primary kidney transplants minimizes bowel obstruction risk compared to repeat surgeries involving laparotomy.

Observation:

• Internal hernia is an infrequent cause of small bowel obstruction post-kidney transplant.
• Diagnosis and intervention for internal hernias after kidney transplantation can be delayed due to diagnostic challenges.
• A case is presented of a 34-year-old man with acute kidney injury and bowel obstruction.

Findings:

• The patient underwent an intra-abdominal third renal transplant.
• A diagnosis of internal hernia was made, occurring around the transplanted ureter.
• This resulted in a rare double obstruction: ureteric obstruction and small bowel obstruction.

Implications:

• This case underscores the importance of considering internal hernia in patients with bowel obstruction after multiple kidney transplants.
• It highlights the potential for complex, combined obstructions in advanced renal retransplantation.
• Further research into surgical techniques and diagnostic protocols for high-risk retransplant patients may be warranted.