Article ; Online: Preservation of native sigmoid colon for secondary continent cystostomy after multivisceral transplantation for chronic intestinal pseudo-obstruction.
2021 Volume 26, Issue 2, Page(s) e14180
Abstract: Chronic intestinal pseudo-obstruction (CIPO) is characterized by severe digestive +/- urinary dysmotility. If the conservative management fails, multivisceral transplantation (MVT) may be needed. However, urinary dysmotility remains after MVT and ... ...
| Abstract | Chronic intestinal pseudo-obstruction (CIPO) is characterized by severe digestive +/- urinary dysmotility. If the conservative management fails, multivisceral transplantation (MVT) may be needed. However, urinary dysmotility remains after MVT and requires to continue urinary catheterizations and/or drainage. We report on a boy with severe CIPO complicated by (1) chronic intestinal obstruction requiring total parenteral nutrition, decompression gastrostomy, and ileostomy; (2) recurrent line infections; (3) hepatic fibrosis; and (4) distension of the bladder and upper urinary tract, and recurrent urinary infections, leading to non-continent cystostomy for urinary drainage. He underwent MVT at the age of 5 years. The transplant included the liver, stomach, duodenum and pancreas, small bowel, and right colon. The distal native sigmoid colon was preserved. Fifteen months later, he underwent a pull through of the transplanted right colon (Duhamel's procedure), together with a tube continent cystostomy (Monti's procedure) using the native sigmoid. Postoperative course was uneventful, and the remaining ileostomy was closed 3 months later. Five years post-transplant, he is alive and well. He is fed by mouth with complementary gastrostomy feeding at night. He has 3-6 stools per day, with occasional soiling. The cystostomy is used for intermittent urinary catheterization 4 times/day and continuous drainage at night. He is dry, with rare afebrile urinary infections, normal renal function, and un-dilated upper urinary tract. Conclusion: in severe CIPO with urinary involvement, preservation of the distal native sigmoid colon during MVT allows secondary creation of a continent tube cystostomy, which is useful to manage persistent urinary disease. |
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| MeSH term(s) | Catheter-Related Infections/therapy ; Child, Preschool ; Colon, Sigmoid ; Cystostomy/methods ; Gastrostomy ; Humans ; Ileostomy ; Intestinal Obstruction/surgery ; Intestinal Pseudo-Obstruction/surgery ; Liver Cirrhosis/surgery ; Male ; Parenteral Nutrition ; Urinary Tract Infections/therapy ; Viscera/transplantation |
| Language | English |
| Publishing date | 2021-11-08 |
| Publishing country | Denmark |
| Document type | Case Reports |
| ZDB-ID | 1390284-2 |
| ISSN | 1399-3046 ; 1397-3142 |
| ISSN (online) | 1399-3046 |
| ISSN | 1397-3142 |
| DOI | 10.1111/petr.14180 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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