CONTRAST EXAMINATION OF THE SMALL-BOWEL IN PATIENTS WITH SMALL-BOWEL TRANSPLANTS - FINDINGS IN 16 PATIENTS

OBJECTIVE. The purpose of this study was to describe the findings on c ontrast examinations of the gastrointestinal tract in patients with sm all-intestinal transplants. SUBJECTS AND METHODS. Sixteen consecutive adult transplant recipients received a total of 17 allografts: eight i solated small-bowel, six small-bowel and liver, and three multiviscera l (stomach, duodenum, pancreas, small-bowel, liver). Grafts included t he entire mesenteric small bowel. Gastrointestinal contrast studies we re done in asymptomatic patients according to protocol and in patients having clinical indications for examination. Median time from transpl antation to examination was 78 days (range, 5-768 days). Seventy-five gastrointestinal contrast examinations were performed: 53 upper gastro intestinal and small-intestinal series, 12 upper gastrointestinal seri es, eight enteroclyses, and two water-soluble contrast enemas. Radiogr aphs were analyzed for postsurgical anatomy, integrity of anastomoses, allograft radiologic appearance, small-bowel transit time, and rate o f gastric emptying. RESULTS. Usual postsurgical anatomy included nativ e-to-donor duodenojejunal, jejunojejunal, and gastrogastric anastomose s and donor-to-native ileocolonic and ileoileal anastomoses. No anasto motic complications were found. Leaks at native duodenal and colonic s tumps resulted in a duodenocutaneous fistula and an abscess, respectiv ely. Moderate to marked thickening of mucosal folds consistent with ed ema was present in nine allografts (53%) and 11 (17%) of 66 upper gast rointestinal and small-intestinal examinations, primarily in the early postoperative period. Chronic loss of allograft mucosal folds develop ed in four grafts in three patients; pathologic diagnoses included acu te and chronic rejection and enteric infection; a jejunocutaneous fist ula developed in one such patient. Transit times of barium through the small intestine ranged from 0.2 to 17.8 hr (median, 2 hr). Self-limit ed delayed gastric emptying was present in 14 patients (88%) and 32 (6 0%) of 54 upper gastrointestinal and small-intestinal examinations. CO NCLUSION. Gastrointestinal contrast examinations in recipients of smal l-bowel transplants are useful for assessing graft anatomy, enteric an astomoses, and gastrointestinal motor function. Most intestinal grafts showed normal caliber and mucosal pattern and exhibited active perist alsis. Abnormal findings included self-limited postoperative edema of graft mucosal folds, chronic loss of the mucosal folds due to rejectio n and/or enteric infection, delayed gastric emptying that improved wit h time, leaks from native duodenal and colon stumps, and a jejunocutan eous fistula in a failing graft. Small-intestinal transit times were s imilar to those observed in patients not receiving transplants, althou gh there was wide variation.