Clinical cases of late postoperative adhesive intestinal obstruction after liver and kidney transplantation in children and surgical methods of their treatment

Abstract

Abdominal adhesions are one of the most common complications in abdominal surgery. In 56-70 % it is the cause of small bowel obstruction, which often requires repeated surgery. To date, a few cases of late adhesive intestinal obstruction (LAIO) as a complication of organ transplantation in children have been described. The purpose of the study was to investigate clinical cases of LAIO in a 9-year-old child after liver transplantation, and in an 8-year-old child after kidney transplantation. Materials and methods. Clinical case I. A 62-day-old girl was treated with Kasai procedure before a liver transplantation, according to type III atresia of the biliary tract. Orthotopic liver transplantation of the left-lateral section from living related donor was performed at the age of 9 months. The surgeries were accompanied by damage to the mesothelium and trauma of the serous membrane, which led to the formation of intraabdominal adhesions. With the growth of the child there was a growth of abdominal organs and adhesions stretching. LAIO was diagnosed 8 years after first surgery. Clinical case II. The boy was diagnosed with hypoplastic dysplasia of the right kidney, left-side ureterohydronephrosis, resulting in chronic end-stage renal disease. Peritoneal dialysis was performed at the age of 6 years. The effect of dialysate on the mesothelium led to the formation of small intestine pseudo-diverticula. At the age of 7 years a bilateral nephrectomy and kidney transplantation from a deceased donor were performed. At the age of 8 LAIO was diagnosed. In both cases, children underwent adhesiolysis. The peritoneum was sutured from the lower and upper edges of the wound to the middle, so that a hole remained in the middle of the wound. A Nelaton catheter was inserted through the hole and 250 ml of sodium hyaluronate solution “Defensal” was injected into the left-lateral part, small pelvis and right lateral abdominal cavity. Then anterior abdominal wall was sutured. Results. The successful surgical treatment of LAIO in children using local adhesiolysis in combination with sodium hyaluronate was performed. The careful handling of vascular anastomoses and changes in organ topography were required during surgery. The purpose of the surgery on LAIO was not only to restore the chyme transport in the gastrointestinal tract, but also to release the small intestine from the adhesions with the normal anatomy and function preservation. The observation of children for 5 years indicate the effectiveness of intraabdominal application of sodium hyaluronate solution. Conclusion. The purpose of surgeries for LAIO after organ transplantation should be to restore the gastrointestinal patency and the functional capacity of the intestine, without violating the previous anatomy and prevention of recurrence. To prevent the intraabdominal adhesions, sodium hyaluronate can be used intraoperatively.