General Considerations

The overall management of surgical disease after transplantation generally follows the fundamental principles appropriate for all surgical illnesses. However, among important considerations the effects of immunosuppressant medications that can result, at times, in serious underestimation of disease severity must be emphasized. Accordingly, a high level of suspicion is always important, and occasionally it becomes necessary to proceed with operative exploration to establish a firm diagnosis.

Additionally, when a disease management algorithm might reasonably include a conservative versus a bold option, we generally favor the less risky approach. This offers the likelihood of more frequent success, recognizing that immunosuppressed transplant recipients enjoy diminished reserve when compared to average patients. For example, a transplant patient with an intestinal perforation or necrosis is usually better managed with segmental resection and creation of an "ostomy," when

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