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Abdominal infection combined with pneumoperitoneum after renal transplantation: A case report
Zhiming Deng1, Huachen Zhu, Wei Du
1Organ Transplantation Department, The First People's Hospital of Changde City, Changde, China.
Introduction:
Abdominal infection combined with pneumoperitoneum after renal transplantation is rare, clinically confusing, and easily misdiagnosed by physicians as gastrointestinal perforation.
Patient Concerns:
A 54-year-old man experienced abdominal pain and distension together with signs of peritoneal irritation after cadaveric renal transplantation. CT and standing abdominal plain film showed a large pneumoperitoneum in the abdominal cavity and the patient underwent an exploratory laparotomy but no gastrointestinal perforation was found.
Diagnosis:
No gastrointestinal perforation was found during the operation. In the search for the infectious agent, ascites culture was negative while next-generation sequencing was positive, suggesting the presence of intestinal flora ectopic to abdominal infection with anaerobic respiration fermentation leading to large amounts of gas.
Interventions:
The patient underwent exploratory laparotomy without gastrointestinal perforation, and then underwent abdominal lavage, placed abdominal drainage tube, and conducted culture and next-generation sequencing examination of ascites.
Outcomes:
Postoperative symptoms were relieved and intestinal function recovered. After 3 months of outpatient follow-up, the patient had stable transplanted kidney function and was in good spirits and sleeping well, with a good appetite, soft and regular stools, no abdominal pain and distension, and no fever.
Conclusion:
Patients after kidney transplantation should be wary of abdominal infection being misdiagnosed as gastrointestinal perforation.
Insights
Abdominal infection post-kidney transplant can mimic gastrointestinal perforation. Early diagnosis using advanced techniques like next-generation sequencing is crucial for appropriate treatment and patient recovery.
Area of Science:
- Nephrology
- Transplant Surgery
- Infectious Diseases
Background:
- Post-renal transplantation, abdominal infection with pneumoperitoneum presents a diagnostic challenge.
- This rare condition is often misdiagnosed as gastrointestinal perforation, delaying appropriate management.
Observation:
- A 54-year-old male recipient developed abdominal pain and distension post-transplant.
- Imaging revealed significant pneumoperitoneum, leading to exploratory laparotomy which excluded gastrointestinal perforation.
Findings:
- Ascites culture was negative, but next-generation sequencing identified ectopic intestinal flora.
- This suggested anaerobic fermentation as the source of gas, causing pneumoperitoneum in the absence of perforation.
Implications:
- Highlights the importance of considering abdominal infection in transplant recipients with pneumoperitoneum.
- Emphasizes the utility of next-generation sequencing in identifying unusual pathogens and guiding treatment.
- Underscores the need for vigilance to prevent misdiagnosis of gastrointestinal perforation.
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