Contrast examination of the small bowel in patients with small-bowel transplants: findings in 16 patients.

OBJECTIVE

The purpose of this study was to describe the findings on contrast examinations of the gastrointestinal tract in patients with small-intestinal transplants.

SUBJECTS AND

METHODS

Sixteen consecutive adult transplant recipients received a total of 17 allografts: eight isolated small-bowel, six small-bowel and liver, and three multivisceral (stomach, duodenum, pancreas, small-bowel, liver). Grafts included the entire mesenteric small bowel. Gastrointestinal contrast studies were done in asymptomatic patients according to protocol and in patients having clinical indications for examination. Median time from transplantation to examination was 78 days (range, 5-768 days). Seventy-five gastrointestinal contrast examinations were performed: 53 upper gastrointestinal and small-intestinal series, 12 upper gastrointestinal series, eight enteroclyses, and two water-soluble contrast enemas. Radiographs were analyzed for postsurgical anatomy, integrity of anastomoses, allograft radiologic appearance, small-bowel transit time, and rate of gastric emptying.

RESULTS

Usual postsurgical anatomy included native-to-donor duodenojejunal, jejunojejunal, and gastrogastric anastomoses and donor-to-native ileocolonic and ileoileal anastomoses. No anastomotic complications were found. Leaks at native duodenal and colonic stumps resulted in a duodenocutaneous fistula and an abscess, respectively. Moderate to marked thickening of mucosal folds consistent with edema was present in nine allografts (53%) and 11 (17%) of 66 upper gastrointestinal and small-intestinal examinations, primarily in the early postoperative period. Chronic loss of allograft mucosal folds developed in four grafts in three patients; pathologic diagnoses included acute and chronic rejection and enteric infection; a jejunocutaneous fistula developed in one such patient. Transit times of barium through the small intestine ranged from 0.2 to 17.8 hr (median, 2 hr). Self-limited delayed gastric emptying was present in 14 patients (88%) and 32 (60%) of 54 upper gastrointestinal and small-intestinal examinations.

CONCLUSION

Gastrointestinal contrast examinations in recipients of small-bowel transplants are useful for assessing graft anatomy, enteric anastomoses, and gastrointestinal motor function. Most intestinal grafts showed normal caliber and mucosal pattern and exhibited active peristalsis. Abnormal findings included self-limited postoperative edema of graft mucosal folds, chronic loss of the mucosal folds due to rejection and/or enteric infection, delayed gastric emptying that improved with time, leaks from native duodenal and colon stumps, and a jejunocutaneous fistula in a failing graft. Small-intestinal transit times were similar to those observed in patients not receiving transplants, although there was wide variation.