Ogilvie's syndrome following renal transplantation.

Gastrointestinal complications following renal transA 65-year-old man (A−, HbsAg−, CMV+, HCV−) with end-stage renal disease (minimal-change glomplantation are not unusual, they include gastritis and ulcer of the stomach or duodenum in about 20% of erulonephritis) was admitted for cadaveric renal transplantation, after receiving conventional haemodialysis the cases, disordered motility with paralytic ileus in 5%, and colonic perforation in 2%. Most of these for the previous 3 years. There was no history of gastrointestinal complaints. The patient received a cadacomplications can be treated successfully by conservative means, but colonic perforation is associated with a veric kidney on a double immunosuppressive protocol, high mortality rate of 30–60% [1–9]. It has been suggested that high-dose corticosteroid rejection therapy, CMV infection, ischaemic or pseudomembranous colitis, and graft dysfunction play a role in severe gastrointestinal complications post-transplant, but there is little evidence to support a direct causative effect with any of these various factors. ‘Ogilvie’s syndrome’ or acute colonic pseudoobstruction was first described by H. Ogilvie in 1948 [10]. The archetypal patient reported by Ogilvie suffered months of abdominal distension and colicky pain. At surgery malignant invasion through the coeliac axis was found, but the colon, while dilated, appeared otherwise healthy and not obstructed. Ogilvie’s syndrome is characterized by dilatation of the distal colon or of the caecum and right colon without any mechanical obstruction, and is known to occur in association with many medical and surgical conditions. When it occurs following abdominal surgery, certain factors are common, namely prior chronic constipation, diabetic autonomic neuropathy, retroperitoneal haematoma, electrolyte disturbance, treatment with opioid analgesics, kayexalate, and other drugs. It has been suggested that the pathogenesis of Ogilvie’s syndrome is a persisting neurapraxia of the sacral parasympathetic nerves 2–4 associated with a severe underlying illness or injury [11–15]. In spite of the increasing number of renal transplants, a typical case of Ogilvie’s syndrome after renal transplant has