DIAGNOSIS AND TREATMENT OF BOWEL PERFORATION FOLLOWING PEDIATRIC ORTHOTOPIC LIVER-TRANSPLANTATION

Objective: Bowel perforation is a frequent cause of mortality after pe diatric orthotopic liver transplantation. The aims of this study were to identify the cause of this phenomenon and to examine current method s of treatment. Design: This is a retrospective analysis of 246 pediat ric patients who underwent orthotopic liver transplantation at a large , urban, tertiary care medical center between 1984 and 1992. We examin ed the frequency of bowel perforations after transplantation and ident ified predisposing factors and signs. In this series, bowel perforatio ns occurred in 24 of 246 recipients and were common in those who had p revious liver-related surgery (22 patients). Clinical signs included f ever (13 patients), leukocytosis (14 patients), and free air on abdomi nal roentgenograms (11 patients). Results: Perforation occurred at the Roux-en-Y limb in 15 of 24 recipients as well as in the right transve rse colon (five patients), terminal ileum (three patients), and duoden um (one patient). The repair was resection and/or primary closure (18 patients), or diversion (six patients), Recurrent perforations (nine p atients) could not be attributed to the method of the repair. Perforat ion-related sepsis was the primary cause of death in 12 patients (50%) and was more common among patients who developed recurrent perforatio n (seven [78%] of nine patients). Conclusions: The occurrence and loca tion of bowel perforation after pediatric orthotopic liver transplanta tion suggests that the cause is related to bowel injury during difficu lt hepatectomy. Mortality may be reduced by early second-look operatio ns in high-risk patients.