Beware the band adhesion: An unexpected cause of small bowel obstruction following intraperitoneal kidney transplantation
David Tovmassian1,2, Ahmer Hameed1,2, Jinna Yao1,2, Kirily Keats1,2, Henry Pleass1,2,3.
1National Pancreas Transplant Unit, Westmead Hospital, Westmead, Australia; 2Faculty of Medicine and Health, University of Sydney, Camperdown, Australia; 3Department of Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
Small bowel obstruction (SBO) following intraperitoneal renal transplantation, either solitary or due to simultaneous pancreas-kidney (SPK) transplantation is a known complication. Most commonly SBO is due to adhesions however there have been documented cases of internal herniation following SPK with enteric drainage due to the formation of a mesenteric defect. We present an unreported complication of internal herniation of small intestine between renal allograft and ureter which had strangulated. Due to the rarity of this complication at index operation the ureter was mistaken for a band adhesion and divided. This led to post-operative anuria the cause of which was difficult to diagnose. Eventual re-laparotomy and ureteric reimplantation with Boari flap was required. It is therefore important to consider the ureter as a cause of internal herniation in transplant patients pre-operatively.
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