Cecal volvulus with necrosis following deceased-donor renal transplantation

A 55-year-old woman with end-stage renal disease secondary to IgA nephropathy underwent an uneventful de novo deceased-donor kidney transplantation under induction with intravenous solumedrol 250？mg × 2 and antithymocyte globulin 1.5？mg × 2. Postoperative renal allograft sonography was unremarkable and she continued to make adequate urine. An immunosuppressive regimen with tacrolimus maintained at a level of 8–10？ug/L, mycophenolate mophetil 1000？mg two times per day, and prednisone 10？mg po once daily was started. On the third postoperative day, the patient developed abdominal distention and inability to tolerate oral intake. Initial abdominal CT scan showed prominent colonic distention involving portions of the small bowel but no mechanical obstruction. With conservative management, the abdominal distention and pain continued to progress with increasing sinus tachycardia. A repeat CT scan demonstrated a cecal diameter of 12？cm, with small foci of extra luminal air along the ascending colon, and a small amount of free fluid throughout the peritoneal cavity but no contrast extravasation. Decision was made to proceed with a diagnostic laparoscopy. Intraoperatively, it was converted to an open laparotomy because of unexpected finding of cecal volvulus (figure 1) with ischemia (figure 2)