Pneumatosis Intestinalis and Pneumoperitoneum After Lung Transplantation: Single-Center Experience and Systematic Review.

IF 0.9 Q3 SURGERY Journal of Transplantation Pub Date : 2024-10-17 eCollection Date: 2024-01-01 DOI:10.1155/2024/8867932
Hiroshi Kagawa, Masashi Furukawa, Ernest Chan, Matthew Morrell, Pablo G Sanchez
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Abstract

Background: Pneumatosis intestinalis (PI) and pneumoperitoneum are some of the complications after lung transplantation (LT). But only limited reports are published. The purpose of this study is to review our experience and perform a systematic review to discuss the possible causes, risk factors, and management. Methods: We reviewed the characteristics, management, and outcome of the patients who developed PI or pneumoperitoneum after LT in our institution from 2013 to 2022. We also performed a systematic review to discuss the management and outcome. Results: PI and pneumoperitoneum were found in 15 out of 729 patients (2.06%) in our institution. We also found 50 patients in the systematic review. Tracheostomy was performed in 40% and gastrointestinal procedures were performed in 55.6%. Laparotomy was performed in 23.4%. A total of 44.6% of patients had benign physical exams or no symptoms. Rejection was seen in 42.9%. A total of 28.6% of patients died during follow-up periods. Conclusions: This report has the largest number of patients so far with PI and pneumoperitoneum after LT. These conditions have a high rejection and high mortality rate. Mechanical ventilation, tracheostomy, gastrointestinal procedure, CMV infection, Clostridium difficile (C. difficile) infection, and immunosuppression can be the risk factors, and the management includes laparotomy or conservative management. It is generally recommended to proceed with laparotomy if patients have portal venous gas, elevated white blood cell count, elevated lactic acid level, decreased bicarbonate level, elevated amylase level, metabolic acidosis, abdominal tenderness, or abdominal distension. Otherwise, most of the patients recover with conservative management with nil per os (NPO), metronidazole, ganciclovir, antibiotics, high-flow oxygen, and holding mycophenolate mofetil (MMF).

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肺移植术后肠道肺炎和腹腔积气:单中心经验与系统回顾
背景:肠积气(PI)和腹腔积气是肺移植(LT)后的一些并发症。但目前发表的报告有限。本研究旨在回顾我们的经验,并进行系统回顾,讨论可能的原因、风险因素和处理方法。方法:我们回顾了我院 2013 年至 2022 年期间在 LT 术后出现 PI 或腹腔积气的患者的特征、处理方法和预后。我们还进行了系统性回顾,讨论了处理方法和结果。结果在我院的 729 例患者中,有 15 例(2.06%)出现了 PI 和腹腔积气。我们还在系统综述中发现了 50 例患者。40%的患者进行了气管切开术,55.6%的患者进行了胃肠道手术。23.4%的患者进行了腹腔手术。共有 44.6% 的患者体检结果为良性或无症状。42.9%的患者出现排斥反应。共有 28.6% 的患者在随访期间死亡。结论:本报告是迄今为止LT术后PI和腹腔积气患者人数最多的报告。这些情况具有高排斥性和高死亡率。机械通气、气管切开、胃肠道手术、CMV 感染、艰难梭菌(C. difficile)感染和免疫抑制可能是风险因素,处理方法包括开腹手术或保守治疗。如果患者出现门静脉积气、白细胞计数升高、乳酸水平升高、碳酸氢盐水平降低、淀粉酶水平升高、代谢性酸中毒、腹部压痛或腹胀,一般建议进行开腹手术。在其他情况下,大多数患者都能通过保守治疗康复,包括无药(NPO)、甲硝唑、更昔洛韦、抗生素、高流量供氧和维持霉酚酸酯(MMF)。
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4.00%
发文量
5
审稿时长
16 weeks
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