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 journalArticlepeer-review

    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

    Keywords

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

    ASJC Scopus subject areas

    • Surgery

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