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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 3: Computed tomography (CT) scan demonstrated pneumatosis intestinalis (white arrows) involving the entire bowel with pneumoperitoneum (white arrowheads) and pneumoretroperitoneum (white arrowheads) (A-C). After 1 week of treatment, gas was almost completely resolved (D).
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Figure 2: Imaging of the case 3: Computed tomography (CT) scan demonstrated pneumatosis intestinalis (white arrows) involving the entire bowel with pneumoperitoneum (white arrowheads) and pneumoretroperitoneum (white arrowheads) (A-C). After 1 week of treatment, gas was almost completely resolved (D).

Mentions: A 53-year-old man with no underlying diseases underwent LDLT using a modified right lobe due to HBV-associated LC and hepatocellular carcinoma (HCC). The biliary reconstruction method was duct-to-duct anastomosis (Table 1). After 2 months, diagnosis of PI was made incidentally on a routine CT scan, which demonstrated PI in the right ascending colon with small pneumoperitoneum (Fig. 2). The patient had no symptoms associated with PI and no sign of secondary complications, and was well maintained on a regular diet without specific antibiotic therapy. Routine immunosuppressive agents, except for steroids, were maintained. A follow-up CT scan after 3 weeks revealed 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 3: Computed tomography (CT) scan demonstrated pneumatosis intestinalis (white arrows) involving the entire bowel with pneumoperitoneum (white arrowheads) and pneumoretroperitoneum (white arrowheads) (A-C). After 1 week of treatment, gas was almost completely resolved (D).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Imaging of the case 3: Computed tomography (CT) scan demonstrated pneumatosis intestinalis (white arrows) involving the entire bowel with pneumoperitoneum (white arrowheads) and pneumoretroperitoneum (white arrowheads) (A-C). After 1 week of treatment, gas was almost completely resolved (D).
Mentions: A 53-year-old man with no underlying diseases underwent LDLT using a modified right lobe due to HBV-associated LC and hepatocellular carcinoma (HCC). The biliary reconstruction method was duct-to-duct anastomosis (Table 1). After 2 months, diagnosis of PI was made incidentally on a routine CT scan, which demonstrated PI in the right ascending colon with small pneumoperitoneum (Fig. 2). The patient had no symptoms associated with PI and no sign of secondary complications, and was well maintained on a regular diet without specific antibiotic therapy. Routine immunosuppressive agents, except for steroids, were maintained. A follow-up CT scan after 3 weeks revealed 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