Between a Rock and a Hard Place-Colonic Obstruction Between Two Kidneys: A Case Report

We report a case of a 70-year-old woman with a history of end-stage renal disease secondary to polycystic kidney disease with a previous failed transplant who presented for a cadaveric extraperitoneal renal transplant. The patient developed a progressively worsening bowel obstruction postoperatively and evidence of an obstruction was observed on computed tomography imaging with a transition point at the level of the sigmoid colon. Consequent to this, she underwent an exploratory laparotomy, which revealed kinking of the colon secondary to the compression between the transplanted and the left native polycystic kidneys. There were adhesive bands between the native kidney and the descending colon in the retroperitoneal space maintaining it in a fixed position mechanically. The addition of a retroperitoneal transplant exacerbated this kink and was responsible for the bowel obstruction. Her left colon was completely mobilized to relieve her obstruction, and owing to her bowel distension, her abdomen was left open for 2 days before returning to the operating room to remove her left native polycystic kidney to allow space for safe closure. This report highlights an extremely unusual cause of large bowel obstruction post-kidney transplantation.