Preservation of native sigmoid colon for secondary continent cystostomy after multivisceral transplantation for chronic intestinal pseudo‐obstruction. (8th November 2021)

• Record Type: Journal Article
• Authors: Grosman, Julien; Aigrain, Yves; Goulet, Olivier; Lacaille, Florence; Capito, Carmen; Chardot, Christophe
• Is Part Of: Pediatric transplantation. Volume 26:Number 2(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-11-08
• Subjects: continent cystostomy -- intestinal failure -- intestinal pseudo obstruction -- megacystis -- multivisceral transplantation; Transplantation of organs, tissues, etc. in children -- Periodicals; 617.95408305
• DOI: 10.1111/petr.14180
• Languages: English
• ISSNs: 1397-3142

Abstract

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.