Intestinal Pneumatosis Following Liver Transplantation, a Rare Condition with High Morbidity: A Case Report

Abstract

Pneumatosis cystoides intestinalis is an uncommon condition, and although various causes have been proposed, associations with medications and transplantation are extremely rare. We report a case of intestinal pneumatosis in a woman who developed the condition 20 days after undergoing a liver transplant. Initially attributed to intestinal obstruction caused by adhesions, the patient underwent laparotomy for adhesiolysis. However, the pneumatosis persisted, and the affected intestinal surface increased despite medical treatment. Concurrently, the patient experienced a viral respiratory infection with secondary thrombocytopenia, leading to the discontinuation of mycophenolate. This intervention resulted in improvement in both the imaging findings of intestinal pneumatosis and associa­ted symptomatology. The perpetuation of this condition in the patient was likely linked to the use of mycophenolate, as the patient improved once the medication was discontinued. Abdominal tomography represents the gold standard technique for diagnosing intestinal pneumatosis, as well as for evaluating its extent and complications. Generally, a favorable outcome is achieved with conservative treatment, as cases requiring surgical management have a poor prognosis.

Keywords

• liver transplantation
• mycophenolic acid
• pneumatosis cystoides intestinalis