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Abstract

Objectives: The aim of this study was to evaluate the incidence, possible risk factors, clinical presentation, and follow-up of patients with a gastrointestinal perforation after liver transplant. Perforations were located in the stomach (n = 1), jejunum (n = 3), ileum (n = 2), jejunum and ileum (n = 1), and colon (n = 2). Seven patients were managed by ostomies, and 2 by primary repair. Despite administration of proper antibiotic therapy and fluid resuscitation to all patients, 2 adults died of septic shock: 1 was caused by perforation and 1 was caused by anastomotic leakage after colostomy closure. Conclusions: A gastrointestinal perforation after a liver transplant is a rare but mortal complication.Considering delayed wound healing owing to immunosuppression, potentially larger ischemic tissue around the perforation site owing to cautery burns and the atypical clinical course that may be further masked by bile leakage, ostomy treatment should be preferred to primary repair. A loop ostomy for small and large bowel perforations after the liver transplant decreases mortality and morbidity.

Gastrointestinal perforation in liver transplantation recipients: risk factors analysis from a 10-year retrospective study with an international multicenter survey about management strategies

“…reported a series of 187 adult LT with an incidence of 6 GI perforations and a mortality of 50%, without analysis of risk factors or different management options according to the site of perforation [14]. Similarly, other 2 papers from Middle and Eastern Asia experiences show a superimposable incidence and mortality rate, within a population of less than 300 LT [16,17].…”

Gastrointestinal perforation after liver transplantation

“…Previous laparotomy has been reported as a contributing factor to gastrointestinal perforation after liver transplantation. [1][2][3][4][5] A previous history of laparotomy would make the dissection more challenging because of the tight intraabdominal adhesion. Isolating the stomach and intestine from dense adhesions increases the risk of iatrogenic injury, which leads to gastrointestinal perforation.…”

“…Earlier reports and studies raised a variety of possible risk factors, including previous laparotomy history, steroid therapy, prolonged portal venous cross-clamp time, portal venous thromboembolism and cytomegalovirus infection. 1,2 Patients often receive steroid and immune therapy post-liver transplantation, which might make reduce symptoms less typical once a perforation of the alimentary tract occurs. Moreover, patients are also at high risk of infection caused by perforation, which seriously affects graft survival and outcome.…”