• Zhiming Deng, Huachen Zhu, Wei Du, and Hongwei Zhang.
• Organ Transplantation Department, The First People's Hospital of Changde City, Changde, China.
• Medicine (Baltimore). 2023 Feb 3; 102 (5): e32836e32836.

IntroductionAbdominal infection combined with pneumoperitoneum after renal transplantation is rare, clinically confusing, and easily misdiagnosed by physicians as gastrointestinal perforation.Patient ConcernsA 54-year-old man experienced abdominal pain and distension together with signs of peritoneal irritation after cadaveric renal transplantation. CT and standing abdominal plain film showed a large pneumoperitoneum in the abdominal cavity and the patient underwent an exploratory laparotomy but no gastrointestinal perforation was found.DiagnosisNo gastrointestinal perforation was found during the operation. In the search for the infectious agent, ascites culture was negative while next-generation sequencing was positive, suggesting the presence of intestinal flora ectopic to abdominal infection with anaerobic respiration fermentation leading to large amounts of gas.InterventionsThe patient underwent exploratory laparotomy without gastrointestinal perforation, and then underwent abdominal lavage, placed abdominal drainage tube, and conducted culture and next-generation sequencing examination of ascites.OutcomesPostoperative symptoms were relieved and intestinal function recovered. After 3 months of outpatient follow-up, the patient had stable transplanted kidney function and was in good spirits and sleeping well, with a good appetite, soft and regular stools, no abdominal pain and distension, and no fever.ConclusionPatients after kidney transplantation should be wary of abdominal infection being misdiagnosed as gastrointestinal perforation.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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