Beware the band adhesion: an unexpected cause of double obstruction following intraperitoneal kidney transplantation. Issue 8 (14th August 2020)

• Record Type: Journal Article
• Authors: Tovmassian, David; Tang, Linda; Hameed, Ahmer M; Yao, Jinna; Yoon, Peter Daechul; Lee, Taina; Laurence, Jerome M; Yuen, Lawrence P K; Allen, Richard D M; Lau, Howard; Pleass, Henry C C
• Is Part Of: Journal of surgical case reports. Volume 2020:Issue 8(2020)
• Publication Date: 2020-08-14
• Subjects: transplant -- allograft -- obstruction -- adhesion -- bowel; Surgery -- Periodicals; Surgery -- Case studies -- Periodicals; 617.005
• DOI: 10.1093/jscr/rjaa239
• Languages: English
• ISSNs: 2042-8812

Abstract

Abstract: Small bowel obstruction (SBO) following intraperitoneal renal transplantation, either solitary or due to simultaneous pancreas-kidney transplantation, is a known complication. While SBO is most commonly due to adhesions, there have been documented cases of internal herniation following simultaneous pancreas-kidney transplantation with enteric drainage due to the formation of a mesenteric defect. We present a unique complication in which the transplant ureter has caused strangulation and necrosis of a length of small intestine. The transplant ureter was mistaken for a band adhesion and divided. Post-operative anuria signalled this difficult diagnosis. Subsequent re-look laparotomy and ureteric reimplantation with Boari flap were required. Therefore, it is important to consider the ureter as a cause of internal herniation in kidney transplant patients and recognize that a band adhesion within the pelvis may in fact be the transplant ureter, obstructing a loop of small intestine beneath its course.