Small-bowel obstruction due to Bezoar following pancreas transplantation with portal-enteric drainage: a case report.
BACKGROUND
Despite recent improvements, surgical complications continue to occur frequently after pancreas transplantation, remaining the leading cause of early graft loss. Small-bowel obstruction, however, is exceedingly rare; it has not been associated with an enhanced risk of graft loss.


METHODS
Intestinal obstruction occurred 7 days after pancreas transplantation due to bezoar blockage at the level of the jejunojejunostomy of the Roux-en-Y loop, which had been constructed to drain the exocrine secretions of the pancreas graft.


RESULTS
CT scan promptly identified the foreign body and greatly facilitated graft rescue before duodenal rupture or the development of graft pancreatitis. Nineteen months after repeat laparotomy the patient is alive with good pancreatic endocrine function.


CONCLUSIONS
In cases of pancreas transplantation with enteric drainage, obstruction of the Roux-en-Y loop may create a totally sealed system that may lead to severe duodenal dilation and eventually to duodenal rupture or graft pancreatitis.
Boggi
U
U
Divisione di Chirurgia Generale e Trapianti, Università di Pisa, Pisa, Italy.
Vistoli
F
F
Morelli
L
L
Del Chiaro
M
M
Bartolo
T Vanadia
TV
Coletti
L
L
Fossati
N
N
Amorese
G
G
Berchiolli
R
R
Mosca
F
F
D001630:Bezoars / Q000175:diagnosis*; D004322:Drainage; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology*; D007431:Intraoperative Complications / Q000175:diagnosis*; D007583:Jejunum; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects*; D011169:Portal Vein; D016896:Treatment Outcome