Abstract
BackgroundSimultaneous pancreas and kidney transplantation (SPK) is a treatment option for patients with end-stage renal disease due to type 1 diabetes mellitus. We report a patient with a refractory fistula due to leakage from the duodenal stump of the pancreas graft after an SPK with bladder drainage who was successfully treated with a percutaneous direct injection of N-butyl-2-cyanoacrylate (NBCA).Case presentationA 60-year-old female with a 33-year history of type 1 diabetes mellitus and a 10-year history of renal replacement therapy underwent an SPK in 2015. At the time of transplantation, an abdominal aortic aneurysm with a high risk of rupture was treated by a Y-graft replacement prior to the SPK. Bladder drainage of the pancreas graft was chosen to avoid a vessel graft infection. The patient’s postoperative course was uneventful. The patient was discharged on postoperative day 93 with good-functioning pancreas and kidney grafts. One and a half years after the operation, the patient was found to have acute graft pancreatitis and a leak from the duodenal stump of the pancreas graft due to a paralytic neurogenic bladder. The insertion of an indwelling catheter into the bladder and the endoscopic-guided insertion of a catheter into the graft pancreatic duct through the duodenum/bladder anastomosis did not result in the closure of the fistula. Therefore, NBCA was injected at the site of the leak point using CT-guided technique. The fistula was completely closed immediately after the injection, with no recurrences of leaks.ConclusionsA percutaneous direct injection of NBCA is one of the treatment options to treat intractable fistulas.
Highlights
Simultaneous pancreas and kidney transplantation (SPK) is a treatment option for patients with endstage renal disease due to type 1 diabetes mellitus
We present a patient with a refractory fistula due to leakage from the duodenal stump of the pancreas graft after SPK with bladder drainage
To reduce tissue injury by pancreatic exogenous fluid at the site of the leak, an endoscopic pancreatic catheter (Cliny5Fr α ENBD) was placed into the transplanted pancreas duct through the Conclusions In cadaveric pancreas transplantations, the pancreas graft is ectopically transplanted into the retroperitoneal space or at the iliac fossa, and the duodenum of the pancreas graft is anastomosed to the small bowel or the bladder to provide pancreatic exocrine drainage
Summary
Simultaneous pancreas and kidney transplantation (SPK) is a treatment option for patients with endstage renal disease due to type 1 diabetes mellitus. Conclusions: A percutaneous direct injection of NBCA is one of the treatment options to treat intractable fistulas. *Correspondence: masaaki@w8.dion.ne.jp 2 Department of Transplant Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita‐15 Nishi‐7, kita‐ku, Sapporo 060‐8638, Japan Full list of author information is available at the end of the article Background Simultaneous pancreas and kidney transplantation (SPK) is a treatment option for patients with chronic renal failure due to type 1 diabetes mellitus.
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