Intestinal Pneumatosis Following Liver Transplantation, a Rare Condition with High Morbidity: A Case Report
DOI:
https://doi.org/10.17533/udea.iatreia.281Keywords:
Liver Transplantation, Mycophenolic Acid, Pneumatosis Cystoides IntestinalisAbstract
Pneumatosis cystoides intestinalis is an uncommon condition, and although various causes have been proposed, associations with medications and transplantation are extremely rare. We report a case of intestinal pneumatosis in a woman who developed the condition 20 days after undergoing a liver transplant. Initially attributed to intestinal obstruction caused by adhesions, the patient underwent laparotomy for adhesiolysis. However, the pneumatosis persisted, and the affected intestinal surface increased despite medical treatment. Concurrently, the patient experienced a viral respiratory infection with secondary thrombocytopenia, leading to the discontinuation of mycophenolate. This intervention resulted in improvement in both the imaging findings of intestinal pneumatosis and associated symptomatology. The perpetuation of this condition in the patient was likely linked to the use of mycophenolate, as the patient improved once the medication was discontinued. Abdominal tomography represents the gold standard technique for diagnosing intestinal pneumatosis, as well as for evaluating its extent and complications. Generally, a favorable outcome is achieved with conservative treatment, as cases requiring surgical management have a poor prognosis.
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(1) Heng Y, Schuffler MD, Haggitt RC, Rohrmann CA. Pneumatosis intestinalis: a review. Am J Gastroenterol [Internet]. 1995;90(10):1747-58. Available from: https://pubmed.ncbi.nlm.nih.gov/7572888/
(2) Im J, Anjum F. Pneumatosis Intestinalis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK564381/
(3) Park CS, Hwang S, Jung DH, Song GW, Moon DB, Ahn CS, et al. Pneumatosis intestinalis after adult living donor liver transplantation: report of three cases and collective literature review. Korean J Hepatobiliary Pancreat Surg [Internet]. 2015;19(1):25-29. Available from: https://pubmed.ncbi.nlm.nih.gov/26155273/
(4) Alghanim F, Deepak J, Iacono A, Timofte I. Mycophenolate adverse effect masquerading as extensive pneumatosis intestinalis (PI) after lung transplantation. Int J Respir Pulm Med [Internet]. 2021;8(2):155. https://doi.org/10.23937/2378-3516/1410155
(5) Telegrafo M, Stabile-Ianora AS, Angelelli G, Moschetta M. Reversible pneumatosis cystoides intestinalis after liver transplantation. G Chir [Internet]. 2017;38(5):239-242. https://doi.org/10.11138/gchir/2017.38.5.239
(6) Kwon HJ, Kim KW, Song GW, Kim DY, Chung SY, Hwang S, et al. Pneumatosis intestinalis after liver transplantation. Eur J Radiol [Internet]. 2011;80(3):629-636. https://doi.org/10.1016/j.ejrad.2010.08.009
(7) Gemma V, Mistrot D, Row D, Gagliano RA, Bremner RM, Walia R, et al. Pneumatosis intestinalis in solid organ transplant recipients. J Thorac Dis [Internet]. 2018;10(3):1984-1997. https://doi.org/10.21037/jtd.2018.02.52
(8) Janssen DA, Kalayoglu M, Sollinger HW. Pneumatosis cystoides intestinalis following lactulose and steroid treatment in a liver transplant patient with an intermittently enlarged scrotum. Transplant Proc [Internet]. 1987;19(2):2949-52. Available from: https://pubmed.ncbi.nlm.nih.gov/3551239/
(9) Burress GC, Ben-Ami T, Whitington PF. Pneumatosis intestinalis in infants after orthotopic liver transplantation. J Pediatr Gastroenterol Nutr [Internet]. 1996 Dec;23(5):577-82. https://doi.org/10.21037/jtd.2018.02.52
(10) Khan U, Dhaduk G, Goveas R. A rare case of pneumatosis intestinalis due to tacrolimus in bone marrow transplant patient. Abstract published at Hospital Medicine 2019, March 24-27, National Harbor, MD. Abstract 759. https://shmabstracts.org/abstract/a-rare-case-of-pneumatosis-intestinalis-due-to-tacrolimus-in-bone-marrow-transplant-patient/
(11) Uneze U, Nubong T, Vakharia S, Amoun T, Lee J. Where is All This Air Coming from? A Rare Case of Pneumatosis Intestinalis with Extensive Pneumoperitoneum and Pneumomediastinum in Lung Transplant Patient Secondary to Mycophenolate Therapy. J Heart Lung Transplant [Internet]. 2022;41(4, Suppl):S427. https://doi.org/10.1016/j.healun.2022.01.1076
(12) Aljamal A, Nair S, Elbanna A, Abu-Sayf A. Pneumatosis intestinalis in a heart and lung transplant patient. Chest [Internet]. 2019;156(4):a1335. https://doi.org/10.1016/j.chest.2019.08.1197
(13) Gómez-Cuesta N, Ayon-Ho, Stanley J, Caviedes-Merchán AM. Neumatosis intestinal. Acta Gastroenterol Latinoam [Internet]. 2015 Sep;45(3):225-9. Available from: https://pubmed.ncbi.nlm.nih.gov/28590607/
(14) Koep LJ, Peters TG, Starzl TE. Major colonic complications of hepatic transplantation. Dis Colon Rectum [Internet]. 1979;22(4):218-20. https://doi.org/10.1007/BF02586877
(15) DuBose JJ, Lissauer M, Maung AA, Piper GL, O’Callaghan TA, Luo-Owen X, et al. Pneumatosis Intestinalis Predictive Evaluation Study (PIPES): a multicenter epidemiologic study of the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg [Internet]. 2013;75(1):15-23. https://doi.org/10.1097/TA.0b013e318298486e
(16) Tahiri M, Levy J, Alzaid S, Anderson D. An approach to pneumatosis intestinalis: Factors affecting your management. Int J Surg Case Rep [Internet]. 2015;6:133-7. https://doi.org/10.1016/j.ijscr.2014.12.007
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