Pneumatosis intestinalis after adult liver transplantation / 대한외과학회지

Pneumatosis intestinalis is an uncommon disorder characterized by an accumulation of gas in the bowel wall. We described three cases undertaking liver transplantation. The patients developed diarrhea in three cases and high fever in two. An abdominal X-ray and computed tomography scan demonstrated extensive pneumatosis intestinalis in the colon with pneumoperitoneum mimicking hollow organ perforation. However, the patients had no abdominal symptoms and there was no evidence of peritonitis. The infection work-up was negative except one case with cytomegalovirus antigenemia. After one week of conservative management including bowel rest and antibiotic therapy, their pneumoperitoneum resolved spontaneously without any complication. Pneumatosis intestinalis should be considered as a differential diagnosis after adult liver transplantation with patients suffering from watery diarrhea and fever. Pneumoperitoneum, air-density in mesentery and retroperitoneum in patients with pneumatosis intestinalis without signs of peritonitis improved with conservative management, which included bowel rest and antibiotic therapy.

Aspergillosis in Liver Transplant Recipients: A Single Center Experience

PURPOSE: The aim of this study was to review the epidemiology, clinical features, diagnosis, and effect of treatments of aspergillosis infections in adult liver transplantation patients. METHODS: We retrospectively studied the cases of aspergillosis among 625 (164 deceased donor liver transplantation (DDLT), 461 living donor liver transplantation (LDLT)) adult liver transplantation recipients (> or =18 yrs old) operated between May 1996 to May 2008. RESULTS: Fourteen cases of aspergillosis infection were detected, which consisted of 9 cases of invasive aspergillosis, 5 cases of aspergilloma in maxillary sinuses which occurred before the transplantation. One patient with invasive aspergillosis, who had received liver transplantation overseas and had post-operation care in our center, was also included. Among the 8 cases (1.28%) of invasive aspergillosis (excluding one case operated overseas), 6 cases (3.7%) were DDLT and 2 cases (0.4%) LDLT (P-value<0.05). Among the 6 patients with early onset of invasive aspergillosis, 5 patients (1.8%) had fluconazole and only 1 patient (0.3%) had itraconazole as prophylactic antifungal agent (P-value<0.05). The three cases with localized lesions in the lung survived after lobectomy, but the disseminated and inoperable cases died. CONCLUSION: The incidence of invasive aspergillosis was lower in LDLT cases and prophylactic itraconazole might be more effective than fluconazole. Paranasal aspergilloma, detected before transplantation had no relation with posttransplant invasive aspergillosis infection. Patients who had localized lesion in the lung, and underwent surgery had better survival than who could not.