Sigmoid Colon Perforation Occurred in 12 years after Renal Transplantation

Hiroaki Takeshita, Takashi Tsuji, Terumitsu Sawai, Shigekazu Hidaka, Shinichi Shibazaki, Kenji Tanaka, Atsushi Nanashima, Tohru Yasutake, Tohru Nakagoe and Takeshi Nagayasu

Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences

A 45-year-old man who had undergone a renal transplantation from a living donor 12 years earlier was admitted for abdominal pain. Because leukocytosis was elevated, we coducted abdominal CT, which showed massive pneumoretroperitoneum and free air in the abdominal cavity, necessitating emergency surgery. The mid sigmoid colon had been perforated, so, we conducted Hartmann's operation, resecting the perforated region, making a stoma of the oral colon, and closing the anal rectum. Postoperative pathological examination did not evidence cytomegalovirus infection or a neoplastic region, but the diverticulum was suspicious. Immunosuppression therapy using cyclosporine, mizoribine, and methyl prednisolone was continued postoperatively but reduced to cyclosporine and methyl prednisolone. No major complications occurred and the transplanted kidney still functioned. Generally, in posttransplantations, abnormal conditions occur due to immunosuppressive agents used to suppress rejection reaction, corticosteroid hormones that induce tissue fragility, and deteriorated tissue curability due to low renal function. In the 12 cases of colon perforation after renal transplantation reported in Japan, the trend involves male cadaver transplantation and sigmoid colon perforation. Nine of these patients have survived, 1 has lost transplanted renal function, and 2 have died.

Key words
renal transplantation, colon perforation, immunosuppression therapy

Reprint requests
Hiroaki Takeshita Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences
1-7-1 Sakamoto, Nagasaki, 852-8501 JAPAN

Accepted
November 30, 2005

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