Gastrointestinal system perforations after pediatric liver transplantation
Sema Aktaş, Aydıncan Akdur, Gökhan Moray, Mehmet Haberal
Başkent Üniversitesi, Genel Cerrahi, Ankara, Türkiye
Purpose: Gastrointestinal (GI) perforation is one of the causes of mortality after pediatric liver transplantation (LT). The aim of this study was to evaluate the incidence of clinical presentations, and outcomes of gastrointestinal perforations after pediatric LTs.
Patients and Methods: Since September 2001, 135 pediatric LTs were performed for 132 children in our center. Four (2.6%) of these 132 children experienced GI perforation in the follow-up when analyzed retrospectively. The etiology for LT was biliary atresia in 3 children and Wilson's disease in the remaining child. Three of them had a history of portoenterostomy and 1 of them have had splenectomy before LT.
Results: All perforations occurred in the first postoperative week. The patients with GI perforation were found to have fever, increased leukocyte counts, mild abdominal pain, tenderness and distention. We performed abdominal CT to all patients to diagnose the perforation. All children had Roux-en-Y hepaticojejunostomy, and perforations were not associated with the operation. The sites of perforation were at the duodenum in 1 child, at the jejunum in 2, and at the colon-hepatic flexura in the remaining 1 patient. Primary repair using two layer suture was performed in all children. We did not encounter any morbidity and mortality after operations. The operated children were followed 102, 85, 57 and 42 months, respectively. When this document was prepared, all of the 4 children were alive with good graft function.
Conclusion: Among risk factors of bowel perforation, history of abdominal surgery may have a role. It should be kept in mind that, to decrease morbidity and mortality, early diagnosis is the most important factor.
Keywords: Liver transplantation, perforation, biliary atresia