Graft Duodenal Perforation due to Internal Hernia after Simultaneous Pancreas-Kidney Transplantation: Report of a Case
Although complications including graft thrombosis, graft pancreatitis, and rejection have been well documented after pancreas transplantation, the occurrence of graft duodenal perforation is uncommon. In this article, we report a case of graft duodenal perforation due to internal hernia after simult...
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2008-07-01
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doaj-a9fc4e5f9a1e4183884d03be429bf48b2020-11-25T01:54:59ZengKarger PublishersCase Reports in Gastroenterology1662-06312008-07-012224424910.1159/000136017136017Graft Duodenal Perforation due to Internal Hernia after Simultaneous Pancreas-Kidney Transplantation: Report of a CaseYuichi FumimotoMasahiro TanemuraYoshihiko HoshidaToshirou NishidaYoshiki SawaToshinori ItoAlthough complications including graft thrombosis, graft pancreatitis, and rejection have been well documented after pancreas transplantation, the occurrence of graft duodenal perforation is uncommon. In this article, we report a case of graft duodenal perforation due to internal hernia after simultaneous pancreas-kidney transplantation (SPK). A patient with type I diabetes mellitus and diabetic nephropathy had undergone SPK from a cadaveric donor. One year later, she was admitted to our hospital for severe lower abdominal pain with preshock status. She was immediately examined by abdominal computed tomography and both peripancreas graft fluid accumulation and severe dilatation of the ileum were detected. On emergency operation, two punched holes located at the graft duodenal side near the suture line and an obstruction of herniated bowel behind the graft pancreas were detected. These holes were repaired and the internal hernia was reduced. However, a control of the intraabdominal infection was very difficult despite intensive treatment with antibiotics and additional abdominal drainage. Finally, a graft pancreatectomy was unavoidably required. When complications, including symptomatic intraabdominal infection, require re-laparotomy after pancreas transplantation, the therapeutic focus should be switched from salvaging the graft to the preservation of life.http://www.karger.com/Article/FullText/136017Type I diabetes mellitusPancreas transplantationIntraabdominal infectionGraft duodenal perforationGraft pancreatectomy |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Yuichi Fumimoto Masahiro Tanemura Yoshihiko Hoshida Toshirou Nishida Yoshiki Sawa Toshinori Ito |
spellingShingle |
Yuichi Fumimoto Masahiro Tanemura Yoshihiko Hoshida Toshirou Nishida Yoshiki Sawa Toshinori Ito Graft Duodenal Perforation due to Internal Hernia after Simultaneous Pancreas-Kidney Transplantation: Report of a Case Case Reports in Gastroenterology Type I diabetes mellitus Pancreas transplantation Intraabdominal infection Graft duodenal perforation Graft pancreatectomy |
author_facet |
Yuichi Fumimoto Masahiro Tanemura Yoshihiko Hoshida Toshirou Nishida Yoshiki Sawa Toshinori Ito |
author_sort |
Yuichi Fumimoto |
title |
Graft Duodenal Perforation due to Internal Hernia after Simultaneous Pancreas-Kidney Transplantation: Report of a Case |
title_short |
Graft Duodenal Perforation due to Internal Hernia after Simultaneous Pancreas-Kidney Transplantation: Report of a Case |
title_full |
Graft Duodenal Perforation due to Internal Hernia after Simultaneous Pancreas-Kidney Transplantation: Report of a Case |
title_fullStr |
Graft Duodenal Perforation due to Internal Hernia after Simultaneous Pancreas-Kidney Transplantation: Report of a Case |
title_full_unstemmed |
Graft Duodenal Perforation due to Internal Hernia after Simultaneous Pancreas-Kidney Transplantation: Report of a Case |
title_sort |
graft duodenal perforation due to internal hernia after simultaneous pancreas-kidney transplantation: report of a case |
publisher |
Karger Publishers |
series |
Case Reports in Gastroenterology |
issn |
1662-0631 |
publishDate |
2008-07-01 |
description |
Although complications including graft thrombosis, graft pancreatitis, and rejection have been well documented after pancreas transplantation, the occurrence of graft duodenal perforation is uncommon. In this article, we report a case of graft duodenal perforation due to internal hernia after simultaneous pancreas-kidney transplantation (SPK). A patient with type I diabetes mellitus and diabetic nephropathy had undergone SPK from a cadaveric donor. One year later, she was admitted to our hospital for severe lower abdominal pain with preshock status. She was immediately examined by abdominal computed tomography and both peripancreas graft fluid accumulation and severe dilatation of the ileum were detected. On emergency operation, two punched holes located at the graft duodenal side near the suture line and an obstruction of herniated bowel behind the graft pancreas were detected. These holes were repaired and the internal hernia was reduced. However, a control of the intraabdominal infection was very difficult despite intensive treatment with antibiotics and additional abdominal drainage. Finally, a graft pancreatectomy was unavoidably required. When complications, including symptomatic intraabdominal infection, require re-laparotomy after pancreas transplantation, the therapeutic focus should be switched from salvaging the graft to the preservation of life. |
topic |
Type I diabetes mellitus Pancreas transplantation Intraabdominal infection Graft duodenal perforation Graft pancreatectomy |
url |
http://www.karger.com/Article/FullText/136017 |
work_keys_str_mv |
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