Successful Management of a Ruptured Mycotic Pseudoaneurysm Following Pancreas Transplantation Using Bovine Pericardial Patch: A Case Report

• Published in: Transplantation proceedings 2014-07, Vol.46 (6), p.2023-2025
• Main Authors: Yiannoullou, P, van Dellen, D, Khambalia, H, Forgacs, B, Tavakoli, A, Murray, D, Augustine, T
• Format: Article
• Language: English
• Subjects: Adult; Aneurysm, False - diagnosis; Aneurysm, False - etiology; Aneurysm, False - surgery; Aneurysm, Infected - diagnosis; Aneurysm, Infected - etiology; Aneurysm, Infected - surgery; Animals; Blood Vessel Prosthesis; Cattle; Humans; Iliac Aneurysm - diagnosis; Iliac Aneurysm - etiology; Iliac Aneurysm - surgery; Kidney Transplantation - adverse effects; Male; Pancreas Transplantation - adverse effects; Pericardium - transplantation; Surgery; Vascular Grafting
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2014.06.051

Abstract Arterial mycotic pseudoaneurysms are a rare complication of pancreas transplantation. Rupture results in catastrophic hemorrhage with a high risk of mortality. Definitive management is complicated by an extensive arterial defect within a contaminated surgical field. Synthetic vascular grafts often fail due to subsequent graft infection whereas primary repair often results in arterial stenosis. Arterial ligation may be required to prevent exsanguination. A 41-year-old man, type 1 diabetic with associated renal failure, underwent successful simultaneous pancreas and kidney transplantation. He presented, 9 months following transplantation, with life-threatening rectal bleeding secondary to a ruptured mycotic pseudoaneurysm. This was successfully managed with a bovine pericardial patch (BPP) repair of the arterial defect and enteric diversion following graft pancreatectomy. He remains well with no vascular insufficiency 18 months following the procedure. A ruptured mycotic pseudoaneurysm following transplantation carries a significant risk of mortality and represents a surgical challenge as conventional techniques using synthetic materials often fail due to the contaminated field. A BPP offers good handling characteristics, excellent hemostatic properties and a favorable profile of infection risk in comparison with synthetic grafts. This case highlights its use as a treatment for a post-transplantation ruptured mycotic pseudoaneurysm.