Unexpected Colonic Perforation in a Renal Recipient. A Case Report

Background: Gastrointestinal complications such as gastrointestinal bleeding and perforation due to immunosuppressant use are seen more frequently after solid organ transplantation.
Case: A 52 year-old male is admitted on the 7th day of a living donor renal transplantation with serous drainage at incision site. He didn’t have any abdominal complaints. He was on triple immunosuppressant therapy. Abdominal plain X-ray and US were found normally, but diffuse extraluminal air was detected at CT scan. There weren’t any pathological laboratory findings regarding to the function of the renal allograft. We began the operation laparoscopically and then converted to laparotomy. Sigmoid colonic perforation was detected on the antimesenteric side. Neither diverticulitis nor ischemia was observed, no evidence about iatrogenic injury was seen. And there was no transrectal instrumentation history. Omentoplasty and sigmoid loop colostomy was performed. He was discharged on the 9th day of the operation. His colostomy was closed on the first year of the operation.
Conclusion: Gastrointestinal complications can be fatal, but don’t seem to influence the long term survival or renal allograft function. Most of them are seen after using high doses of immunosuppressants to manage early postoperative period or episodes of acute rejection. Early diagnosis and aggressive treatment play an important role on survival.