Clinical Presentation

Recipients with wound infections or intra-abdominal abscesses may present with any of the following: fever, abdominal pain, wound dehiscence, and purulent wound drainage. On physical examination, pain may be elicited by palpation, and guarding and rebound may be present. Laboratory abnormalities may include leukocytosis with a left shift. However, the absence of leukocytosis or fever does not exclude the presence of infection in the transplant recipient. The definitive diagnosis is achieved by imaging studies such as computerized tomography (CT), ultrasound (US), or magnetic resonance imaging (MRI).

Cholangitis usually manifests with fever and right upper quadrant pain, with tenderness and rebound on palpation of the abdomen. Hyperbilirubinemia, elevated transaminases and alkaline phosphatase levels, as well as leukocytosis, may be found on laboratory testing.

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