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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Main Authors: Yuichi Fumimoto, Masahiro Tanemura, Yoshihiko Hoshida, Toshirou Nishida, Yoshiki Sawa, Toshinori Ito
Format: Article
Language:English
Published: Karger Publishers 2008-07-01
Series:Case Reports in Gastroenterology
Subjects:
Online Access:http://www.karger.com/Article/FullText/136017
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spelling 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
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