Bowel perforation after paediatric orthotopic liver transplantation

Abstract

Bowel perforation is aKey words Liver transplantation, well-recognized complication following orthotopic liver transplantation. Of 194 paediatric liver transplantations performed in our hospital, 13 patients (6.7 YO) developed bowel perforation post-transplantation. Contributory factors included previous operation, steroid therapy and viral infection. The incidence was higher in children who underwent transplantation for biliary atresia after a previous Kasai portoenterostomy. Seven patients (53 Yo of this group) reperforated. Diagnosis may be difficult and a high index of suspicion is needed.intestinal perforation . Intestinal perforation, liver transplantation

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“…The cause of GIP after LT is unclear, but contributing factors include previous abdominal surgery (particularly the Kasai procedure for biliary atresia in children), serosal injury or devascularization of the bowel wall, prolonged LT procedure, retransplant, transfusions, posttransplant intra-abdominal bleeding requiring reoperation, early portal vein thrombosis, high-dose steroid therapy, poor nutritional status, and CMV infection. [2][3][4][9][10][11] The incidence of GIP after LT is 1% to 5.3% in adults and 8.3% to 14% in children. 1, 3, 4, 9-11 The higher incidence in children is most likely attributable to tight adhesions of the liver and formation of intestinal loops during portoenterostomy before LT.…”

“…Further, 115 (95%) of the 121 perforation cases were pediatric, whereas the remaining 6 were adult cases. [1][2][3][4][8][9][10][11][12] We documented that most of the pediatric GIP cases were patients who had undergone a portoenterostomy owing to biliary atresia. Thus, a portoenterostomy procedure performed before LT in children appears to be a serious risk factor.…”

“…A high degree of suspicion is needed, as a delay in diagnosis is associated with significant morbidity and mortality. [8][9][10][11][12] Despite developments in LT surgery, mortality owing to sepsis secondary to GIP is as high as 30% to 50%, and is 30% to 78% after reperforation surgery. 9,11 However, some studies have reported 0% mortality despite a high perforation rate.…”

“…Given that the liver is highly susceptible to iatrogenic injury during transplant, circulatory dysfunction may occur upon portal clamping, and damage to the gastrointestinal mucosal barrier can be induced by high-dose steroids, posttransplant complications are observed most commonly in gastrointestinal organs. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Gastrointestinal complications are common among patients who undergo solid-organ transplant and range from mild to moderate conditions, such as diarrhea or nausea, to more severe, life-threatening complications such as digestive bleeding and gut perforation. 5 Gastrointestinal perforation (GIP), which is potentially lethal, may occur at any point in the gastrointestinal tract, including the stomach, jejunum, ileum, and colon.…”

“Surgicel abscess” after pediatric liver transplantation: A potential trap

“…Appearances of a gas-containing hematoma are alarming and raise concern about the possibility of a localized bowel perforation, which can be difficult to diagnose in an immunosuppressed child after liver transplantation. 1 Other causes include an abscess caused by gas-forming bacteria, air tracking through the biliary tree, and residual gas after removal of an abdominal drain.…”