Posttransplant gastrointestinal perforation in pediatric liver transplantation

The results of 119 consecutive orthotopic liver transplants in 105 pediatric recipients were reviewed to determine the incidence and management of posttransplant gastrointestinal perforation (PTGIP). Transplantation of 22 children (21%) having had no previous surgery resulted in no PTGIP. However, 15 patients (14%) had PTGIP, and this group had had a greater number of previous laparotomies than did 68 children without PTGIP (2.3 +/- 0.9 v 1.5 +/- 0.8; P < .01). Up to 31% of children with two or more previous operations developed PTGIP. The incidence of PTGIP in patients with a preexisting stoma (26%, n = 23) was not significantly different from that in children whose previous portoenterostomy consisted of a simple Roux loop (15%, n = 60). A total of 32 laparotomies were performed for 35 PTGIP. The operative procedures included an oversewing of the perforated site (n = 22), segmental bowel resection/primary anastomosis (n = 5), creation of enterostomy (n = 7), and drainage (n = 1). After these laparotomies, reperforation occurred in 31% of patients, varying from none after defunctioning enterostomy for colonic perforations to 63% after simple oversew of perforated small bowel. Bolus methylprednisolone therapy or cytomegalovirus infection did not show any link with PTGIP. Children having undergone multiple laparotomies before liver transplantation are more susceptible to PTGIP. There was no death directly caused by PTGIP, but morbidity was considerable.