Duodenum–Stomach Anastomosis: a New Technique for Exocrine Drainage in Pancreas Transplantation

Introduction Poor vascular access due to previous surgery can be a major obstacle in pancreas transplantation for which new exocrine and vascular outflow techniques might be useful. A 34-year-old female with early onset type 1 diabetes who underwent living donor kidney transplantation 20 years ago a...

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Published in:Journal of gastrointestinal surgery 2012-05, Vol.16 (5), p.1072-1075
Main Authors: Linhares, Marcelo Moura, Beron, Reinaldo Isaacs, Gonzalez, Adriano Miziara, Tarazona, Cristian, Salzedas, Alcides, Rangel, Erika, Sá, Joao Roberto, Melaragno, Claudio, Goldman, Suzan Menasce, Souza, Marcelo Gonçalves, Sato, Nelson Y., Matos, Delcio, Lopes-Filho, Gaspar Jesus, Medina, Jose Osmar
Format: Article
Language:English
Subjects:
Abdomen
Adult
Anastomosis, Surgical - methods
Case Report
Case reports
Coronary vessels
Diabetes
Drainage - methods
Duodenum - surgery
Female
Follow-Up Studies
Gastroenterology
Graft Rejection - surgery
Humans
Kidney Transplantation - methods
Kidney transplants
Living Donors
Medicine
Medicine & Public Health
Pancreas
Pancreas Transplantation - adverse effects
Pancreas Transplantation - methods
Postoperative Complications - prevention & control
Reoperation - methods
Small intestine
Stomach
Stomach - surgery
Surgery
Surgical techniques
Time Factors
Treatment Outcome
Veins & arteries
Venous access
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Summary:Introduction Poor vascular access due to previous surgery can be a major obstacle in pancreas transplantation for which new exocrine and vascular outflow techniques might be useful. A 34-year-old female with early onset type 1 diabetes who underwent living donor kidney transplantation 20 years ago and a failed pancreas transplantation 2 years ago presented for pancreas retransplantation. Methods The inferior vena cava was used in the previous deceased donor pancreas transplantation and both iliac arteries had intense perivascular fibrosis, making arterial anastomosis impossible. The only remaining option for the implant was the infrarenal aorta, with venous drainage to the superior mesenteric vein and exocrine drainage to the gastric antrum Results The patient had an uneventful recovery and graft function appeared normal. This report shows that when the recipient’s abdominal cavity does not provide clear access for the usual surgical techniques regarding exocrine drainage, the stomach drainage procedure is an option. Conclusion Duodenum–stomach anastomosis might be an alternative to portal enteric drainage because there is easy access for graft biopsies and even for procedures involving the papilla major.
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-011-1806-1