Case Report: Pancreas Graft With a Duodenal Complication Rescued Using Total Duodenectomy

• Published in: Transplantation proceedings 2014-11, Vol.46 (9), p.3068-3071
• Main Authors: Uva, P.D, Villavicencio Fornaciari, S, Giunippero, A.E, Cabrera, I.C, Casadei, D.H
• Format: Article
• Language: English
• Subjects: Anastomosis, Surgical - adverse effects; Diabetes Mellitus, Type 2 - surgery; Digestive System Surgical Procedures - methods; Drainage - methods; Duodenum - surgery; Humans; Kidney Failure, Chronic - surgery; Kidney Transplantation - adverse effects; Male; Middle Aged; Pancreas Transplantation - adverse effects; Postoperative Complications - surgery; Surgery
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2014.07.019

Abstract Simultaneous pancreas-kidney (SPK) transplantation is the treatment of choice for type 1 diabetics with end-stage renal disease. Recently patients with type 2 diabetes have been considered for transplantation. Despite that the patient and graft survival rates have improved over the past years, it continues to be a procedure with high surgical complication rates. We herein report a case of a pancreatic graft with a duodenal complication rescued using a total duodenectomy, a procedure that is seldom used. A 57-year-old type 2 diabetic underwent a SPK transplantation with systemic-enteric drainage. He was converted to a Roux en Y at day 7 for a small duodenal fistula without peritonitis. At day 13, with good graft function, he presented with gastrointestinal and abdominal bleeding. At laparotomy he had a congestive duodenum with intraluminal bleeding and an anastomotic fistula. We performed a total duodenectomy with enteric drainage. The patient was discharged home on day 39 with a pancreatic fistula on intramuscular Octretotide that lasted for 3 months. He was never readmitted and has good pancreas and kidney function at 16 months of follow-up. We think this is an option to rescue a pancreas graft with duodenal complications in selected cases.