Intestinal transplantationRelapsing encephalopathy following small bowel transplantation
Section snippets
Patient and history
A 40-year-old Caucasian male presented with recurrent encephalopathic episodes 4 years after cadaveric small bowel transplantation because of a large mesenteric desmoid tumour. The small bowel graft terminated as a stoma, and the mesenteric vessels had been anastomosed directly to the infra-renal aorta and the inferior vena cava. Maintenance immunosuppressive therapy consisted of low dose prednisolone (5 mg/day) and tacrolimus. He remained independent of parenteral nutrition, maintaining his
Results and discussion
In a review of 31 patients following intestinal transplantation, bacterial overgrowth was found in 27, although hepatic encephalopathy has not been reported.1 The much higher fluctuating serum ammonia levels noted in our patient could be explained by two major factors. First, the graft venous drainage was directly into the inferior vena cava, creating an iatrogenic porto-caval shunt.2, 3, 4
Second, partial small bowel obstruction cuased by stricture formation in the setting of chronic small
References (5)
- et al.
J Surg Res
(1987) - et al.
Kidney Int
(1972)