tacrolimus and Intestinal-Perforation

A 31-year-old woman with systemic lupus erythematosus and lupus nephritis was treated with prednisone and immunosuppressants. After her lupus nephritis symptoms worsened, both high-dose steroid and cyclophosphamide pulse therapy were administered. The patient developed an intestinal perforation, and laparoscopic Hartmann's surgery was performed on the sigmoid colon. Serum Cytomegalovirus (CMV) antigen C7HRP was detected, and the patient was diagnosed with CMV colitis and underwent a colon resection. Severe hematochezia continued despite ganciclovir administration, and the patient underwent laparoscopic total colectomy and partial ileostomy. CMV enteritis should be considered in patients treated with prednisone and immunosuppressants and those who have abdominal pain and hematochezia. Immunocompromised patients with intestinal perforation due to CMV enteritis have a poor prognosis. We report a case with along with the results of a literature review.

Topics: Adult; Antiviral Agents; Betamethasone; Colitis; Colon, Sigmoid; Cytomegalovirus; Cytomegalovirus Infections; Enteritis; Female; Ganciclovir; Gastrointestinal Hemorrhage; Humans; Immunocompromised Host; Immunosuppressive Agents; Intestinal Perforation; Lupus Nephritis; Prednisolone; Tacrolimus

Bowel perforation is an uncommon but serious complication of peritoneoscopic peritoneal dialysis (PD) catheter insertion. The approach to diagnosis of bowel perforation utilizing this technique has not been previously published. The authors report their experience with the diagnosis and management of bowel perforation in the context of peritoneoscopic placement of PD catheters.. The authors retrospectively reviewed the records of 750 PD catheters inserted over a 12-year period (January 1991 to May 2003) utilizing peritoneoscopic technique.. Six (0.8%) patients experienced bowel perforation during the procedure. The diagnosis was made immediately during the procedure in 5 (83%) of the 6 patients. Of these 5, peritoneoscopy confirmed intrabowel position of the cannula by visualizing bowel mucosa (n = 3) and hard stool (n = 1). The fifth patient showed extrusion of fecal matter upon trocar withdrawal before peritoneoscopy. All 5 had emanation of foul-smelling gas through the cannula. Bowel rest and broad-spectrum intravenous antibiotics were initiated. Of the 5, 1 required surgery, whereas the others were discharged home after 3 days. The sixth patient had fever, severe peritoneal irritation, and polymicrobial peritonitis the morning after the procedure. In this patient, no evidence of bowel injury was noted during the procedure except for brief emanation of foul-smelling gas. He required surgical intervention.. Bowel perforation can be diagnosed immediately in most patients undergoing peritoneoscopic PD catheter insertion. A majority of these patients can be treated medically. The surgical team should be consulted if the patient shows clinical deterioration or has signs of peritoneal irritation.

Topics: Abdomen, Acute; Adult; Aged; Anti-Bacterial Agents; Catheterization; Combined Modality Therapy; Diabetic Nephropathies; Drug Therapy, Combination; Feces; Female; Gases; Humans; Immunosuppressive Agents; Intestinal Perforation; Kidney Failure, Chronic; Laparoscopy; Lung Transplantation; Male; Middle Aged; Peritoneal Dialysis; Peritonitis; Postoperative Complications; Retrospective Studies; Surgical Instruments; Tacrolimus

Topics: Arthroplasty, Replacement, Hip; Cecal Diseases; Female; Hepatitis C, Chronic; Humans; Immunosuppressive Agents; Intestinal Perforation; Liver Cirrhosis; Liver Transplantation; Middle Aged; Periprosthetic Fractures; Peritonitis; Tacrolimus; Therapeutic Irrigation