Delayed graft duodenal perforation due to impacted food five years after simultaneous pancreas-kidney transplantation

A case report

Taizo Sakata, Hideki Katagiri, Tadao Kubota, Takashi Sakamoto, Kentaro Yoshikawa, Alan Kawarai Lefor, Cheol Woong Jung, Toru Kojima

Research output: Contribution to journalArticle

Abstract

Introduction Pancreas transplantation is the best treatment option in selected patients with type 1 diabetes mellitus. Here we report a patient with a nonmarginal duodenal perforation five years after a simultaneous pancreas-living donor kidney transplantation (SPLKT). Presentation of case A 31-year old male who underwent SPLKT five years previously presented with severe abdominal pain. He had a marginal duodenal perforation four years later, treated by primary closure and drainage. Biopsy of the pancreas and duodenum graft at that time showed chronic rejection in the pancreas and acute inflammation with an ulcer in the duodenum. At presentation, computerized tomography scan showed mesenteric pneumatosis with enteric leak and ileal dilatation proximal to the anastomotic site. We performed emergent laparotomy and found a 1.0 cm perforation at the nonmarginal, posterior wall of the duodenum. Undigested fiber-rich food was extracted from the site and an omental patch placed over the perforation. An ileostomy was created proximal to the omega loop for decompression and a drain placed nearby. The postoperative course was unremarkable. Discussion There are only eight previous cases of graft duodenal perforation in the literature. Fiber-rich food residue passing through the anastomosis with impaction may have led to this perforation. Conclusion When a patient is stable, even in the presence of delayed duodenal graft perforation, graft excision may not be necessary. Intraoperative exploration should include Doppler ultrasound examination of the vasculature to rule out thrombosis as a contributor to ischemia. Tissue biopsy should be performed to diagnose rejection.

Original languageEnglish
Pages (from-to)69-72
Number of pages4
JournalInternational Journal of Surgery Case Reports
Volume38
DOIs
Publication statusPublished - 2017 Jan 1

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Pancreas Transplantation
Kidney Transplantation
Pancreas
Duodenum
Transplants
Food
Living Donors
Biopsy
Doppler Ultrasonography
Ileostomy
Decompression
Type 1 Diabetes Mellitus
Laparotomy
Abdominal Pain
Ulcer
Dilatation
Drainage
Thrombosis
Ischemia
Tomography

Keywords

  • Case report
  • Chronic rejection
  • Delayed duodenal graft perforation
  • Pancreas transplantation

ASJC Scopus subject areas

  • Surgery

Cite this

Delayed graft duodenal perforation due to impacted food five years after simultaneous pancreas-kidney transplantation : A case report. / Sakata, Taizo; Katagiri, Hideki; Kubota, Tadao; Sakamoto, Takashi; Yoshikawa, Kentaro; Lefor, Alan Kawarai; Jung, Cheol Woong; Kojima, Toru.

In: International Journal of Surgery Case Reports, Vol. 38, 01.01.2017, p. 69-72.

Research output: Contribution to journalArticle

Sakata, Taizo ; Katagiri, Hideki ; Kubota, Tadao ; Sakamoto, Takashi ; Yoshikawa, Kentaro ; Lefor, Alan Kawarai ; Jung, Cheol Woong ; Kojima, Toru. / Delayed graft duodenal perforation due to impacted food five years after simultaneous pancreas-kidney transplantation : A case report. In: International Journal of Surgery Case Reports. 2017 ; Vol. 38. pp. 69-72.
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