Coloduodenovesical Fistula After Simultaneous Pancreas-Kidney Transplant: Case Report and Review of the Literature

• Published in: Transplantation proceedings 2017-10, Vol.49 (8), p.1960-1962
• Main Authors: Rahnemai-Azar, A.A., Penna, M., Morrison, S.D., Rayhill, S.C., Sibulesky, L., Muczynski, K.A., Bakthavatsalam, R.
• Format: Article
• Language: English
• Subjects: Colon, Sigmoid; Diverticulitis - diagnosis; Diverticulitis - etiology; Duodenum; Humans; Intestinal Fistula - diagnostic imaging; Intestinal Fistula - etiology; Kidney Transplantation - adverse effects; Male; Middle Aged; Pancreas Transplantation - adverse effects; Postoperative Complications; Sigmoid Diseases - etiology; Urinary Bladder Fistula - diagnostic imaging; Urinary Bladder Fistula - etiology; Urinary Tract Infections - etiology
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2017.04.009

Complicated diverticulitis after transplantation occurs in as many as 3.5% of cases and carries a 25% mortality rate. Diagnosis of complicated diverticulitis in this population can be challenging because of abnormal presentations caused by immunosuppression. Only 4 cases of fistulization after kidney transplantation are described in the literature; none occurred after simultaneous pancreas-kidney transplant. We present a first case of a coloduodenovesical fistula in a patient 9 years after simultaneous pancreas-kidney transplant. The patient presented with intermittent episodes of elevated creatinine and recurrent urinary tract infection. The presence of fistula was strongly suspected in cystoscopy, but, despite extensive investigation, a fistula tract could not be identified. The patient ultimately underwent surgical exploration for positive cystoscopy examination, continuation of urinary complaints, and presence of multiple colonic diverticula in computed tomography scan. At surgical exploration, a fistula track was identified between the sigmoid colon and duodenal stump of the pancreas allograft. Subsequently, sigmoidectomy, bladder repair, and enteric conversion of the pancreas transplant were performed. Complications of diverticulitis should be considered in organ transplant recipients presenting with recurrent urinary infection and elevated creatinine, and surgical exploration might be indicated even if unable to well-define the fistula tract. •The report describes a first case of coloduodenovesical fistula after spontaneous kidney-pancreas transplant.•Presentation and methods of evaluation are described for enterovesical fistula after organ transplantation.•Surgical treatment of patients with enterovesical fistula in organ transplant is described.