Year: 2012
Type: article
Study design: Case Report
Abstract: The patient is a 67-year-old diabetic female who received a retroperitoneal kidney transplant into the right iliac fossa. Because of a prior history of voiding dysfunction, she was discharged with an indwelling Foley catheter. Ten days after transplantation, she presented to the emergency room with a fever of 101.5 degrees, a new onset of exquisite suprapubic tenderness and dysuria, a white blood cell count of 26.5 × 103 cells/uL and a serum creatinine of 0.9 mg/dL. A CT scan of the abdomen and pelvis with oral and intravenous contrast was performed (Figure 1). She was started on piperacillin and tazobactam but she clinically did not improve over 48 hours. Vancomycin was added. Urine cultures grew >100 000 colony forming units of E. coli. She was then taken to the operating room for a surgical procedure (Figure 2). Operative cultures grew E. coli, streptococcus species, and Lactobaccilus gasseri. Postoperatively, she underwent a percutaneous nephrostogram and placement of a percutaneous nephro-ureteral catheter for urinary diversion (Figure 3). The Foley catheter was maintained. After 3 months of urinary diversion, the catheters were sequentially removed and she has fully recovered with excellent function of the transplanted kidney. She is voiding normally.Figure 2.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3.View Large Image Figure ViewerDownload Hi-res image Download (PPT) 1Based on the CT scan findings, what is the most likely diagnosis?aTransplant pyelonephritisbColonic perforationcFournier’s gangrenedInfected pelvic hematomaeEmphysematous cystitis2Other than pharmacologic immunosuppression and diabetes mellitus, what factor is MOST likely to contribute to the risk of this complication?aPatient age greater than 65bColonic diverticulosiscIndwelling Foley catheterdRecipient obesityeRetroperitoneal placement of transplanted kidney3Why is complete urinary diversion necessary in this patient, as evidenced in Figure 3?aBladder perforation with urinary extravasationbBladder outlet obstructioncStricture of the transplant ureterdLeak of the transplant uretereColonic perforation eroding into renal collecting system4In addition to urinary diversion, what operative procedure is appropriate treatment of this patient?aHematoma evacuation and retroperitoneal drainagebDiverting colostomy and abscess drainagecBladder debridementdRevision of uretero-neocystotomy to uretero-ureterostomyeSeroma marsupialization5What is the most common organism responsible for a gas producing soft tissue infection in an immunosuppressed patient?aGroup A StreptococcusbE. colicClostridium speciesdStaphylococcus specieseEnterococcus
Authors: P.M. Porrett, M.H. Levine
Institution: University of Pennsylvania
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,300
OpenAlex ID: W1983255805