腎移植患者に合併した横行結腸穿孔の１救命例

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  • Transverse colon perforation with kidney transplantation.

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Although patients in shock with colonic perforation often have a poor prognosis, we successfully treated a patient with a 7 year clinical history of kidney transplantation. A 52-year-old woman was seen 10 hours after abrupt onset of severe abdominal pain. Upon arrival, she was in shock suffering from panperitonitis. Plain chest radiography showed intraperitoneal free air. Emergency laparotomy revealed a transverse colon laceration 3cm in diameter on the opposite side of the mesentrium attachment near the splenic flexure. No tumor lesion was seen at the site or its anal side. Partial transverse colectomy was conducted to remove the lesion and primary anastomosis was done with diversion temporary colostomy constructed at the oral site. Postoperatively, the patient underwent endotoxin absorption therapy twice. Continuous hemodiafiltration (CHDF) was also undertaken for 4 consecutive days.<br> The woman was discharged from the hospital without complications on hospital day 131. Histopathological studies showed no other finding than perforation. A search of the Japanese literature showed only 3 patients survived without graft loss of 10 colon-perforation cases after kidney transplantation in the past 18 years.

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