We report the case of a 61-year-old male heart transplant who developed a blind volvulus on the tenth day after surgery.
The patient had cardiomyopathy with ejection fraction of 23% secondary to ischemic heart disease treated with double bypass.
The patient had a history of seizures, hypertension, type 2 diabetes mellitus and chronic renal failure.
He underwent cardiac ortotopic transplantation with bicaval anastomosis.
Ischemia time was 280 min with a cardiopulmonary bypass duration of 200 min and a tendency to hypotension requiring vasoactive drugs and blood products.
She received antibiotic prophylaxis consisting of induction treatment with mycophenolate mofetil, tapering and daclizumab.
In the immediate postoperative period she presented diarrhea and fever, discarding the presence of Clostridium difficile by determination of toxin A and B in stool by enzyme immunoassay.
On the tenth day after surgery, the patient developed severe abdominal pain, abdominal distension, pain on palpation of the right iliac fossa with leukocytosis (35,000 l/mm3).
An urgent CT scan was performed, showing cecal bladder discoloration of up to 12 cm in diameter, compatible with the diagnosis of "cecal bulla" type volvulus.
Emergency laparotomy was performed and cecal volvulus was confirmed with signs of intestinal necrosis without perforation.
Right hemicolectomy was performed with manual ileocolic anastomosis.
The patient developed an uneventful postoperative period.
Anatomopathological report: intestinal hemorrhagic infarction with transmural necrosis.
She was discharged 45 days after transplantation without postoperative abdominal complications.
Graft function was normal, with an ejection fraction of 77% two months after transplantation.
In our experience, acute colonic complications affect 2% of prescriptions, being more frequent in men and with a mean age over 55 years (2.3).
Pathogenesis has been related to treatment, especially with steroids, either because of an episode of acute rejection or due to vomiting in the first days after transplantation.
The other possible cause is gastrointestinal vascular compromise due to previous abdominal vascular pathology or low cardiac output after transplantation (non-obstructive intestinal ischemia) (1-3).
Infections should be ruled out, especially when the patient developed fever, leukocytosis and diarrhoea.
In the first days after transplantation, Clostridium difficile infection causes diarrhea, fever and leukocytosis, ruled out in our case by the determination of toxin A and B (6).
The patient described here had several risk factors such as reoperation, prolonged duration of intervention, transfusion of blood products and need for vasoactive drugs in the immediate postoperative period (dobutamine, noradrenaline).
