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Pneumatosis intestinalis after adult living donor liver transplantation: report of three cases and collective literature review.

Park CS, Hwang S, Jung DH, Song GW, Moon DB, Ahn CS, Park GC, Kim KH, Ha TY, Lee SG - Korean J Hepatobiliary Pancreat Surg (2015)

Bottom Line: Physical examination revealed abdominal distension but no tenderness or rebound tenderness.After 1 week of conservative treatment, including bowel rest and antibiotics therapy, PI and pneumoperitoneum resolved spontaneously without complications.We suggest that adult LDLT recipients who develop asymptomatic or symptomatic PI with no signs of secondary complications can be successfully managed with conservative treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.

ABSTRACT

Backgrounds/aims: Pneumatosis intestinalis (PI) is a condition in which multiple gas-filled mural cysts develop in the gastrointestinal tract. Although its exact etiology remains obscure, PI is rarely observed in liver transplant (LT) recipients.

Methods: In 317 cases of adult living donor LT (LDLT) performed during 2011, PI developed in three patients during the 3 year follow-up.

Results: Of these three patients, the two who demonstrated PI at 6 weeks and 2 months after LT, respectively, were asymptomatic and showed no signs of secondary complications. Diagnosis was made incidentally using abdominal radiographs and computed tomography (CT) scans. PI was identified in the right ascending colon with concomitant pneumoperitoneum. These two patients received supportive care and maintained a regular diet. Follow-up CT scans demonstrated spontaneous resolution of PI with no complications. The third patient was admitted to the emergency room 30 months after LDLT. His symptoms included poor oral intake and intermittent abdominal pain with no passage of gas. Abdominal radiography and CT scans demonstrated PI in the entire small bowel, with small bowel dilatation, pneumoperitoneum, and pneumoretroperitoneum, but no peritonitis. Physical examination revealed abdominal distension but no tenderness or rebound tenderness. After 1 week of conservative treatment, including bowel rest and antibiotics therapy, PI and pneumoperitoneum resolved spontaneously without complications.

Conclusions: We suggest that adult LDLT recipients who develop asymptomatic or symptomatic PI with no signs of secondary complications can be successfully managed with conservative treatment.

No MeSH data available.


Related in: MedlinePlus

Imaging of the case 1 and 2: Computed tomography (CT) scans of case 1 patient revealed pneumatosis intestinalis (PI) (white arrows) involving the right ascending colon on an axial image (A) and a coronal image (B). CT scans of case 2 patient revealed PI (white arrows) involving the right ascending colon (C), which was spontaneously resolved after 3 weeks (D).
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Figure 1: Imaging of the case 1 and 2: Computed tomography (CT) scans of case 1 patient revealed pneumatosis intestinalis (PI) (white arrows) involving the right ascending colon on an axial image (A) and a coronal image (B). CT scans of case 2 patient revealed PI (white arrows) involving the right ascending colon (C), which was spontaneously resolved after 3 weeks (D).

Mentions: A 48-year-old woman with underlying diabetes mellitus and chronic renal failure had undergone dual-graft LDLT using two left lobes due to hepatitis B virus (HBV)- associated liver cirrhosis (LC). Biliary reconstruction was performed using duct-to-duct anastomosis in the right graft and hepaticojejunostomy in the left graft (Table 1). Six weeks after LDLT, PI was diagnosed incidentally on abdomen radiographs and CT scans, which demonstrated PI in the right ascending colon with small pneumoperitoneum (Fig. 1). The patient showed no symptoms associated with PI and no sign of secondary complications such as peritonitis, bowel ischemia, or perforation. She was maintained on a regular diet and was not administered antibiotics. Routine immunosuppressive agents, except for steroids, were continued. After 4 weeks, a follow-up CT scan demonstrated spontaneous resolution of PI with no complications.


Pneumatosis intestinalis after adult living donor liver transplantation: report of three cases and collective literature review.

Park CS, Hwang S, Jung DH, Song GW, Moon DB, Ahn CS, Park GC, Kim KH, Ha TY, Lee SG - Korean J Hepatobiliary Pancreat Surg (2015)

Imaging of the case 1 and 2: Computed tomography (CT) scans of case 1 patient revealed pneumatosis intestinalis (PI) (white arrows) involving the right ascending colon on an axial image (A) and a coronal image (B). CT scans of case 2 patient revealed PI (white arrows) involving the right ascending colon (C), which was spontaneously resolved after 3 weeks (D).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494092&req=5

Figure 1: Imaging of the case 1 and 2: Computed tomography (CT) scans of case 1 patient revealed pneumatosis intestinalis (PI) (white arrows) involving the right ascending colon on an axial image (A) and a coronal image (B). CT scans of case 2 patient revealed PI (white arrows) involving the right ascending colon (C), which was spontaneously resolved after 3 weeks (D).
Mentions: A 48-year-old woman with underlying diabetes mellitus and chronic renal failure had undergone dual-graft LDLT using two left lobes due to hepatitis B virus (HBV)- associated liver cirrhosis (LC). Biliary reconstruction was performed using duct-to-duct anastomosis in the right graft and hepaticojejunostomy in the left graft (Table 1). Six weeks after LDLT, PI was diagnosed incidentally on abdomen radiographs and CT scans, which demonstrated PI in the right ascending colon with small pneumoperitoneum (Fig. 1). The patient showed no symptoms associated with PI and no sign of secondary complications such as peritonitis, bowel ischemia, or perforation. She was maintained on a regular diet and was not administered antibiotics. Routine immunosuppressive agents, except for steroids, were continued. After 4 weeks, a follow-up CT scan demonstrated spontaneous resolution of PI with no complications.

Bottom Line: Physical examination revealed abdominal distension but no tenderness or rebound tenderness.After 1 week of conservative treatment, including bowel rest and antibiotics therapy, PI and pneumoperitoneum resolved spontaneously without complications.We suggest that adult LDLT recipients who develop asymptomatic or symptomatic PI with no signs of secondary complications can be successfully managed with conservative treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.

ABSTRACT

Backgrounds/aims: Pneumatosis intestinalis (PI) is a condition in which multiple gas-filled mural cysts develop in the gastrointestinal tract. Although its exact etiology remains obscure, PI is rarely observed in liver transplant (LT) recipients.

Methods: In 317 cases of adult living donor LT (LDLT) performed during 2011, PI developed in three patients during the 3 year follow-up.

Results: Of these three patients, the two who demonstrated PI at 6 weeks and 2 months after LT, respectively, were asymptomatic and showed no signs of secondary complications. Diagnosis was made incidentally using abdominal radiographs and computed tomography (CT) scans. PI was identified in the right ascending colon with concomitant pneumoperitoneum. These two patients received supportive care and maintained a regular diet. Follow-up CT scans demonstrated spontaneous resolution of PI with no complications. The third patient was admitted to the emergency room 30 months after LDLT. His symptoms included poor oral intake and intermittent abdominal pain with no passage of gas. Abdominal radiography and CT scans demonstrated PI in the entire small bowel, with small bowel dilatation, pneumoperitoneum, and pneumoretroperitoneum, but no peritonitis. Physical examination revealed abdominal distension but no tenderness or rebound tenderness. After 1 week of conservative treatment, including bowel rest and antibiotics therapy, PI and pneumoperitoneum resolved spontaneously without complications.

Conclusions: We suggest that adult LDLT recipients who develop asymptomatic or symptomatic PI with no signs of secondary complications can be successfully managed with conservative treatment.

No MeSH data available.


Related in: MedlinePlus