EP844 - Cecal Volvulus After Deceased Donor Renal Transplantation: To Anastomose, Or Not To Anastomose, That Is The Question.

Purpose/Background: Purpose:
To describe a rare case of postoperative cecal volvulus following deceased donor renal transplantation, and highlight the decision to perform an anastomosis in select patient populations.

Methods/Interventions:

Methods:
A 72-year-old female with chronic kidney disease secondary to hypertension presented initially for deceased donor renal transplantation. She had an extensive pre-operative evaluation from the multi-disciplinary transplant team and was optimized for the procedure. She underwent a right kidney to right iliac fossa deceased donor renal transplantation with back bench renal venoplasty. This was done through an open, retroperitoneal approach and was performed without any immediate perioperative complications.

Results/Outcomes:

Results:
The patient initially tolerated diet advancement however was intermittently experiencing abdominal distension and discomfort. On post-operative day 3 the distension had progressively worsened and she had more abdominal pain. Abdominal X-ray was immediately concerning for cecal volvulus with possibility of free air. She was taken to the operating room for an exploratory laparotomy, ileocolic resection with a stapled side to side functional end to end anastomosis. She had a buried PD catheter that was also removed during this procedure due to the possibility of bacterial seeding. She recovered well from both surgeries. By postoperative day 3 from partial colectomy she was having normal bowel function and tolerating a diet. She was maintained on a standard regimen of immunosuppression throughout hospitalization, and had delayed graft function. She was discharged in stable condition on hospital day 9.

Conclusion/Discussion:

Conclusion:
The decision to perform an anastomosis in a patient actively receiving induction immuno-suppression is difficult. This case highlights a rare complication of renal transplantation, while underscoring the technical considerations of end ileostomy and primary anastomosis. A high output ileostomy can compromise the health of the new kidney if difficult to manage medically. On the other hand, the patient who has a severely suppressed immune system, paired with high dose steroids, and medication induced leukopenia, may not heal an anastomosis. This patient was hemodynamically normal throughout the hospitalization and operation, additionally the colon was very healthy appearing - as such the team opted to perform the anastomosis, maintaining intestinal continuity.