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Gastrointestinal Imaging

E2472. Intestinal Transplants in Adults: Normal Appearance and Complications

Hakim B,  Myers D,  Williams T. Henry Ford Health System, Detroit, MI

Address correspondence to D. Myers (danielm@rad.hfh.edu)

Background Information: Intestinal transplant is one of the least common forms of organ transplant but is increasing both in volume of cases performed and in number of centers performing intestinal transplant. Intestinal failure is the primary underlying medical issue that requires transplantation. Certain occurrences after the initiation of total parental nutrition (TPN) for treatment of intestinal failure are indications for intestinal transplant. These include venous thrombosis preventing TPN access, recurrent catheter-related sepsis, and cholestatic liver disease. Intestinal transplant can be performed as an isolated organ transplant or as part of a multivisceral transplant, including other organs in addition to the small intestine. The type of transplant is important for the radiologist to recognize the normal transplant appearance and the nature of potential complications the patient may have. Typically, intestinal transplants initially have three sites of anastomosis with a proximal enteric anastomosis, an ileocolic anastomosis, and a temporary ileostomy. The ileostomy serves as an access point for surveillance endoscopy and graft biopsies and ultimately may be taken down. There is a paucity of radiology literature regarding evaluation of intestinal transplants. As intestinal transplants are growing in frequency and these patients may be encountered in any practice setting. Therefore, basic knowledge of the transplant appearance and complications has value for all radiologists.

Educational Goals/Teaching Points: The goals of this exhibit are to review the indications for intestinal transplant and describe the normal appearance of an intestinal transplant both as an isolated transplant and as part of a multivisceral transplant. We will also review common and uncommon complications of intestinal transplantation with imaging examples and discuss the role of imaging in identifying those complications.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: This exhibit will focus on the imaging appearance and complications related to the transplanted intestine. Typical transplant anatomy will be reviewed with illustrative imaging. Normal transplant anatomy in regards to enteric and vascular anastomoses will be displayed. Common intestinal transplant complications including infection, rejection, and mechanical bowel complications (leak or perforation, obstruction, and fistula) will be explored with illustrative imaging examples. Less common complications including vascular complications of arterial and venous anastomoses will be reviewed with correlative imaging. Posttransplant lymphoproliferative disorder will also be illustrated. Imaging of complications will be accomplished with a multimodality approach utilizing gastrointestinal fluoroscopy, CT, MR, US, and angiography.

Conclusion: Intestinal transplants are increasing in frequency but remain relatively uncommon. Although many radiologists will not be primarily involved in evaluation of intestinal transplants, basic knowledge of the anatomy and complications may be potentially useful as intestinal transplant patients may be encountered in a variety of settings.