Colon Perforation After Lung Transplantation

• Published in: The Annals of thoracic surgery Vol. 62; no. 3; pp. 839 - 843
• Main Authors: Beaver, Thomas M., Fullerton, David A., Zamora, Martin R., Badesch, David B., Weill, David, Brown, James M., Campbell, David N., Grover, Frederick L.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.1996; Elsevier Science
• Subjects: Adult; Biological and medical sciences; Colonic Diseases - etiology; Diverticulitis, Colonic - complications; Diverticulitis, Colonic - diagnosis; Female; Humans; Immunomodulators; Immunosuppressive Agents - adverse effects; Intestinal Perforation - etiology; Lung Transplantation - adverse effects; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Preoperative Care; Human; Corticosteroid; Perforation; Lung; Bibliographic survey; Transplantation; Prednisone; Homotransplantation; Fungi; Infection; Case study; Aspergillus; Treatment; Surgery; Digestive diseases; Intestinal disease; Complication; Fungi Imperfecti; Colon; Immunosuppressive agent; Thallophyta
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(96)00393-1

Colon perforation has been previously described after solid organ transplantation. Since the inception of the lung transplant program at the University of Colorado 60 isolated lung transplantations have been performed. Four of these patients have suffered spontaneous colonic perforation. The case history of each lung transplant patient with a colon perforation and the literature were reviewed. An increased incidence of colon perforation in lung transplant patients was identified. Diverticulitis was found to be the predominant cause, and an association with steroids was noted. The two deaths in this series were in patients receiving high-dose steroids in whom invasive Aspergillus infections developed. Careful screening of the gastrointestinal tract before transplantation is advocated. A steroid-sparing immunosuppressive regimen is recommended. All lung transplant patients with abdominal complaints require an aggressive work-up, and surgeons should have a low threshold for laparotomy. Conservative surgical principles, including resection of the perforated segment of colon and proximal end-colostomy rather than primary anastomosis, are necessary for the optimal outcome.