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A3096 - Pneumatosis Intestinalis and Pneumoperitoneum in Orthotopic Heart and Bilateral Lung Transplant Recipients
Author Block: D. Djondo1, B. Bemiss2, M. Liebo1; 1Department of Pulmonary Disease and Critical Care, Loyola University Medical Center, Maywood, IL, United States, 2Loyola University Medical Center, Maywood, IL, United States.
Objective: Pneumatosis intestinalis and pneumoperitoneum are rare radiographic findings which have previously been reported in association with organ transplantation with significant heterogeneity of clinical outcomes. The purpose of this study is to determine clinical features, imaging findings and potential causes of pneumatosis intestinalis with pneuoperitoneum in adult recipients of thoracic solid organ transplantation. Materials and Methods: Single center retrospective chart review of heart and lung transplant recipients. From January 2016 to August 2017, 6 thoracic solid organ transplant recipients (5 bilateral lung transplant recipients and 1 orthotopic heart transplant recipient) who developed pneumatosis intestinalis and pneumoperitoneum were identified. Medical records were reviewed to compare the clinical presentation, imaging, laboratory findings, and medications at the time of diagnosis of pneumatosis intestinalis or pneumoperitoneum. Hospital course and time to resolution of pneumatosis intestinalis and pneumoperitoneum were assessed. Results: Of the six patients, all five lung transplant recipients had benign pneumatosis intestinalis. Four of the five lung transplant patients were managed conservatively and one lung transplant patient underwent exploratory laparotomy with negative findings. Mean time to resolution of pneumatosis (or hospital discharge) among lung transplant patients was 7 days. No significant difference in CT findings among the five lung transplant patients was observed - all lung transplant patients had pneumoperitoneum with pneumatosis intestinalis of the ascending and transverse colon. No definite cause for the PI and pneumoperitoneum could be determined in any of the lung transplant patients. The mean time to development of pneumatosis intestinalis was 246 days post-transplant in lung transplant recipients. The heart transplant patient developed life-threatening pneumatosis requiring emergent exploratory laparotomy which demonstrated segmental ischemic necrosis of the hepatic flexure and subsequently underwent a right hemicolectomy. Pneumatosis intestinalis in this patient was likely secondary to ischemic colitis. Notably, the heart transplant patient did not undergo CT imaging of the abdomen prior to surgery due the emergent nature of the case (pneumatosis detected on abdominal plain film imaging). All six patients were receiving at least dual immunosuppressive therapy at time of diagnosis of pneumatosis intestinalis. Conclusion: This is the first reported study, to our knowledge, of pneumatosis intestinalis in both heart and lung transplant recipients. Benign pneumatosis intestinalis, while rare, appears to have a higher incidence in bilateral lung transplant recipients compared to recipients orthotopic heart transplant recipients. The mechanism of pneumatosis intestinalis development in recipients of a thoracic solid organ transplant remains unclear and can be multifactorial.