Acute diverticulitis in heart- and lung transplant patients

Khan, Shahzad Alam; Eppstein, Andrew C.; Anderson, Gina K.; Dengal, M. K.; Eggenberger, John C.; Lee, Chong S.; Szilagy, Eric J.; Margolin, David A.

doi:10.1007/s001470050736

Cited by 7 publications

(11 citation statements)

References 11 publications

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“…It is reported in 0.4%-8% of solid organ transplanted patients with a 0%-83.3% mortality rate [4,8,11,16,[18][19][20] . However, no case of acute diverticulitis in patients with heart-lung transplantation has been reported before, particularly in young patients.…”

Section: Discussionmentioning

confidence: 99%

“…In the study of Qasabian et al, all patients with severe diverticulitis survived and death occurred only in a conservatively treated patient in whom a definite diagnosis was not reached until post-mortem examination was made [18] . Diagnosis of diverticulitis poses a significant challenge in the immunosuppressed patients [11,18,19] . Symptoms and physical examination usually do not reflect the severity of the disease while signs of infection, such as fever and tachycardia, may be absent.…”

Section: Discussionmentioning

confidence: 99%

“…Abdominal CT scan is the most reliable modality in determining the location and degree of pathology. A high index of suspicion, prompt diagnosis, reduction of immunosuppression, and early administration of broad spectrum antibiotics are essential for management and prognosis of these patients [11,[18][19][20] . If bowel perforation is suspected, immediate operative intervention with bowel resection and colostomy is indicated.…”

Section: Discussionmentioning

confidence: 99%

“…If bowel perforation is suspected, immediate operative intervention with bowel resection and colostomy is indicated. In the setting of uncomplicated diverticulitis, it is prudent to proceed with colectomy following resolution of the acute episode, provided the patient is a reasonable operative candidate [11,[18][19][20] . Colon perforation has been observed in 0.5%-5.3% o f s o l i d o r g a n r e c i p i e n t s w i t h a m o r t a l i t y o f 0%-100% [1,[3][4][5][6][13][14][15] .…”

Section: Discussionmentioning

confidence: 99%

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Subclinical peritonitis due to perforated sigmoid diverticulitis 14 years after heart-lung transplantation

Markogiannakis¹,

Konstadoulakis²,

Tzertzemelis³

et al. 2008

WJG

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Acute complicated diverticulitis, particularly with colon perforation, is a rare but serious condition in transplant recipients with high morbidity and mortality. Neither acute diverticulitis nor colon perforation has been reported in young heart-lung grafted patients. A case of subclinical peritonitis due to perforated acute sigmoid diverticulitis 14 years after heart-lung transplantation is reported. A 26-year-old woman, who received heart-lung transplantation 14 years ago, presented with vague abdominal pain. Physical examination was normal. Blood tests revealed leukocytosis. Abdominal X-ray showed air-fluid levels while CT demonstrated peritonitis due to perforated sigmoid diverticulitis. Sigmoidectomy and endcolostomy (Hartmann's procedure) were performed. Histopathology confirmed perforated acute sigmoid diverticulitis. The patient was discharged on the 8th postoperative day after an uneventful postoperative course. This is the first report of acute diverticulitis resulting in colon perforation in a young heart-lung transplanted patient. Clinical presentation, even in peritonitis, may be atypical due to the masking effects of immunosuppression. A high index of suspicion, urgent aggressive diagnostic investigation of even vague abdominal symptoms, adjustment of immunosuppression, broad-spectrum antibiotics, and immediate surgical treatment are critical. Moreover, strategies to reduce the risk of this complication should be implemented. Pretransplantation colon screening, prophylactic pretransplantation sigmoid resection in patients with diverticulosis, and elective surgical intervention in patients with nonoperatively treated acute diverticulitis after transplantation deserve consideration and further studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Subclinical peritonitis due to perforated sigmoid diverticulitis 14 years after heart-lung transplantation

Markogiannakis¹,

Konstadoulakis²,

Tzertzemelis³

et al. 2008

WJG

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“…Other speculative inciting factors include bowel wall ischemia during the perioperative period of transplantation and increased intraluminal pressure due to narcotic‐induced constipation and the use of bowel stimulants [141]. While bowel wall ulceration and perforation by CMV infection is also a plausible mechanism, numerous cases have failed to detect viral pathology [141,148].…”

Section: Nonpulmonary Critical Care Issuesmentioning

confidence: 99%

Critical Care Aspects of Lung Transplant Patients

Chakinala

Kollef

Trulock

2002

J Intensive Care Med

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Chakinala MM, Kollef MH, Trulock EP. Critical care aspects of lung transplant patients. J Intensive Care Med 2002;17:8–33. Major strides have been made in lung transplantation during the 1990s and it has become an established treatment option for patients with advanced lung disease. Due to improvements in organ preservation, surgical techniques, postoperative intensive care, and immunosuppression, the risk of perioperative and early mortality (less than 3 months after transplantation) has declined [1]. The transplant recipient now has a greater chance of realizing the benefits of the long and arduous waiting period. Despite these improvements, suboptimal long‐term outcomes continue to be shaped by issues such as opportunistic infections and chronic rejection. Because of the wider use of lung transplantation and the longer life span of recipients, intensivists and ancillary intensive care unit (ICU) staff should be well versed with the care of lung transplant recipients. In this clinical review, issues related to organ donation will be briefly mentioned. The remaining focus will be on the critical care aspects of lung transplant recipients in the posttransplant period, particularly ICU management of frequently encountered conditions. First, the groups of patients undergoing transplantation and the types of procedures performed will be outlined. Specific issues directly related to the allograft, including early graft dysfunction from ischemia‐reperfusion injury, airway anastomotic complications, and infections in the setting of immunosuppression will be emphasized. Finally nonpulmonary aspects of posttransplant care and key pharmacologic points in the ICU will be covered.

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Acute diverticulitis in immunocompromised patients: evidence from an international multicenter observational registry (Web-based International Register of Emergency Surgery and Trauma, Wires-T)

et al. 2023

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Background Immunocompromised patients with acute diverticulitis are at increased risk of morbidity and mortality. The aim of this study was to compare clinical presentations, types of treatment, and outcomes between immunocompromised and immunocompetent patients with acute diverticulitis. Methods We compared the data of patients with acute diverticulitis extracted from the Web-based International Registry of Emergency Surgery and Trauma (WIRES-T) from January 2018 to December 2021. First, two groups were identified: medical therapy (A) and surgical therapy (B). Each group was divided into three subgroups: nonimmunocompromised (grade 0), mildly to moderately (grade 1), and severely immunocompromised (grade 2). Results Data from 482 patients were analyzed—229 patients (47.5%) [M:F = 1:1; median age: 60 (24–95) years] in group A and 253 patients (52.5%) [M:F = 1:1; median age: 71 (26–94) years] in group B. There was a significant difference between the two groups in grade distribution: 69.9% versus 38.3% for grade 0, 26.6% versus 51% for grade 1, and 3.5% versus 10.7% for grade 2 (p < 0.00001). In group A, severe sepsis (p = 0.027) was more common in higher grades of immunodeficiency. Patients with grade 2 needed longer hospitalization (p = 0.005). In group B, a similar condition was found in terms of severe sepsis (p = 0.002), quick Sequential Organ Failure Assessment score > 2 (p = 0.0002), and Mannheim Peritonitis Index (p = 0.010). A Hartmann’s procedure is mainly performed in grades 1–2 (p < 0.0001). Major complications increased significantly after a Hartmann’s procedure (p = 0.047). Mortality was higher in the immunocompromised patients (p = 0.002). Conclusions Immunocompromised patients with acute diverticulitis present with a more severe clinical picture. When surgery is required, immunocompromised patients mainly undergo a Hartmann’s procedure. Postoperative morbidity and mortality are, however, higher in immunocompromised patients, who also require a longer hospital stay.

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Acute diverticulitis in heart- and lung transplant patients

Cited by 7 publications

References 11 publications

Subclinical peritonitis due to perforated sigmoid diverticulitis 14 years after heart-lung transplantation

Subclinical peritonitis due to perforated sigmoid diverticulitis 14 years after heart-lung transplantation

Critical Care Aspects of Lung Transplant Patients

Acute diverticulitis in immunocompromised patients: evidence from an international multicenter observational registry (Web-based International Register of Emergency Surgery and Trauma, Wires-T)

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