Duodenal graft complications requiring duodenectomy after pancreas and pancreas–kidney transplantation

Autor: Piero Marchetti, Margherita Occhipinti, Gabriella Amorese, Ugo Boggi, Niccolò Napoli, Giovanni Consani, Carla Cappelli, Erica Pieroni, Carlo Lombardo, Davide Caramella, Maurizio De Maria, Fabio Vistoli
Rok vydání: 2018
Předmět:
Adult
Male
medicine.medical_specialty
Duodenum
medicine.medical_treatment
Fistula
Hemorrhage
030230 surgery
Pancreas transplantation
clinical research/practice
surgical technique
Young Adult
03 medical and health sciences
Duodenectomy
0302 clinical medicine
diagnostic techniques and imaging: computed tomography
medicine
Humans
Immunology and Allergy
Ascending colon
Pharmacology (medical)
clinical decision-making
complication: surgical/technical
Transplantation
business.industry
Anastomosis
Surgical
Middle Aged
medicine.disease
Pancreaticoduodenectomy
Kidney Transplantation
pancreas/simultaneous pancreas–kidney transplantation
Surgery
Catheter
surgical procedures
operative
medicine.anatomical_structure
Drainage
Female
030211 gastroenterology & hepatology
Pancreas Transplantation
Pancreas
business
Zdroj: Publons
ISSN: 1600-6135
DOI: 10.1111/ajt.14613
Popis: Duodenal graft complications are poorly reported complications of pancreas transplantation that can result in graft loss. Excluding patients with early graft failure, after a median follow-up period of 126 months (range 23-198) duodenectomy was required in 14 of 312 pancreas transplants (4.5%). All patients were insulin-independent at the time of diagnosis. Reasons for duodenectomy included delayed duodenal graft perforation (n = 10, 71.5%) and refractory duodenal graft bleeding (n = 4, 28.5%). In patients with duodenal graft bleeding, a total duodenectomy was performed. In patients with duodenal graft perforation, preservation of a duodenal segment was possible in five patients but completion duodenectomy was necessary in one patient. After total duodenectomy, immediate enteric duct drainage was feasible in seven patients. In two patients, a pancreaticocutaneous fistula was created that was subsequently converted to enteric drainage in one patient. In the other patient, enteric fistulization occurred as a consequence of silent pressure perforation of the draining catheter on the ascending colon. After a mean follow-up period of 52 months (21-125), all patients were alive, well, and insulin-independent. An aggressive and timely surgical approach may permit graft rescue in patients with severe duodenal graft complications occurring after pancreas transplantation. Generalization of these results remains to be established.
Databáze: OpenAIRE
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