Kasputis Zanini LY, Lima FR, Fernandes MR, Alvarez PSE, Silva MS, Martins Filho APR, Franzini TAP, Nacif LS. Ischemic colitis with small-vessel occlusion, simultaneous total colectomy and liver transplantation: A case report. World J Transplant 2025; 15(2): 98620 [DOI: 10.5500/wjt.v15.i2.98620]
Corresponding Author of This Article
Lucas Souto Nacif, MD, MSc, PhD, Chief Doctor, Chief Physician, Researcher, Surgeon, Department of Liver and Gastrointestinal Transplant, Hospital 9 de Julho, Peixoto Gomide Street, 645-Cerqueira César, São Paulo 01409-002, Brazil. lucasnacif11@gmail.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Jun 18, 2025; 15(2): 98620 Published online Jun 18, 2025. doi: 10.5500/wjt.v15.i2.98620
Ischemic colitis with small-vessel occlusion, simultaneous total colectomy and liver transplantation: A case report
Leonardo Yuri Kasputis Zanini, Fabiana Roberto Lima, Michel Ribeiro Fernandes, Paola Sofia Espinoza Alvarez, Marcello de Souza Silva, Antônio Paulo Ramos Martins Filho, Tomazo Antonio Prince Franzini, Lucas Souto Nacif
Leonardo Yuri Kasputis Zanini, Department of Surgery, Federal University of São Paulo, São Paulo 04023-062, Brazil
Leonardo Yuri Kasputis Zanini, Michel Ribeiro Fernandes, Paola Sofia Espinoza Alvarez, Marcello de Souza Silva, Antônio Paulo Ramos Martins Filho, Lucas Souto Nacif, Department of Liver and Gastrointestinal Transplant, Hospital 9 de Julho, São Paulo 01409-002, Brazil
Fabiana Roberto Lima, Department of Pathology, University of São Paulo School of Medicine, São Paulo 05403-900, Brazil
Fabiana Roberto Lima, Department of Surgical Pathology, Hospital 9 de Julho, São Paulo 01409-002, Brazil
Tomazo Antonio Prince Franzini, Department of Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
Tomazo Antonio Prince Franzini, Department of Endoscopy, Hospital 9 de Julho, São Paulo 01409-002, Brazil
Author contributions: Kasputis Zanini LY, Lima FR and Nacif LS contributed to manuscript writing and editing, and data collection; Fernandes MR, Alvarez PSE, Silva MS, Martins Filho APR, and Franzini TAP conceptualization and revision; Nacif LS contributed with manuscript supervision; all authors have read and approved the final manuscript.
Informed consent statement: The patient signed an informed consent form.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lucas Souto Nacif, MD, MSc, PhD, Chief Doctor, Chief Physician, Researcher, Surgeon, Department of Liver and Gastrointestinal Transplant, Hospital 9 de Julho, Peixoto Gomide Street, 645-Cerqueira César, São Paulo 01409-002, Brazil. lucasnacif11@gmail.com
Received: July 1, 2024 Revised: October 24, 2024 Accepted: December 9, 2024 Published online: June 18, 2025 Processing time: 234 Days and 20 Hours
Abstract
BACKGROUND
The colon is the hollow viscera that proportionally has the lowest vascular supply and is more predisposed to ischemic colitis. In the context of end-stage liver disease, various components may explain this group's greater predisposition to colonic ischemic events. Furthermore, portal hypertension generates a process of coagulopathy, impairing local vascularization. This case report describes a case of ischemic colitis with small-vessel occlusion found during liver transplantation in a patient with decompensated end-stage liver disease.
CASE SUMMARY
A 64-year-old man with liver cirrhosis due to non-alcoholic steatohepatitis and hepatocellular carcinoma. The patient underwent liver transplantation due to hepatic decompensation. The donor was a 53-year-old man who had died of a hemorrhagic stroke. Cavitary examination revealed diffuse ischemic colitis with significant distention and necrosis. Due to the condition of the colon, a subtotal colectomy was performed. Liver transplantation with warm ischemia time of 35 minutes, cold ischemia of 6 hours 30 minutes and total ischemia time of 7 hours 5 minutes. The patient improved clinically with oral tract function and physiotherapy, but unfortunately, he developed a bloodstream infection, a new septic shock and died six months after surgery.
CONCLUSION
Simultaneous total colectomy and orthotopic liver transplantation represent a rare situation. Ischemic events have a high mortality rate in the general population and are particularly important in cirrhotic patients.
Core Tip: This article described simultaneous colectomy and liver transplantation. Despite its rarity, this event should be known by transplant team surgeons, given the high mortality this condition might have.
