Percutaneous embolization of periduodenal varix due to portal hypertension in a patient with kidney-pancreas transplantation: a case report.
Kidney-pancreas transplantation is a valid therapeutic option for patients with insulin-dependent diabetes mellitus. However, vascular complications associated with pancreas transplantation are not uncommon. Herein we have reported a 32-year-old woman with a history of insulin-dependent diabetes mellitus and celiac disease. She underwent liver transplantation for acute hepatitis. After 7 years, the patient developed end-stage kidney disease beginning hemodialysis and being listed for a kidney-pancreas transplantation, which was successfully performed when she was 29 years old with enteric diversion (Roux intestinal loop reconstruction). Five years after kidney-pancreas transplantation, she was admitted to our hospital with serious intestinal bleeding and poor liver function. The ultrasound showed a pattern like a arteriovenous fistula near the head of the pancreas. Computed Tomography was not diagnostic; an arteriogram showed the presence of a mesenteric varix and a mesenteric-caval shunt through the duodenum of the pancreatic graft. The liver biopsy and portal pressure gradient showed portal hypertension and liver cirrhosis. To obtain time a waiting a new liver, the patient underwent percutaneous embolization of the mesenteric varix through jugular access. The procedure was uneventful. The patient was successfully transplanted 2 months later. Pancreas function was always satisfactory.
Fontana
I
I
Department of Transplantation, San Martino University Hospital, Genoa, Italy. iris.fontana@hsanmartino.it
Bertocchi
M
M
Di Domenico
S
S
Andorno
E
E
Santori
G
G
Magoni Rossi
A
A
Gasloli
G
G
Ferro
C
C
Rossi
U G
UG
Bovio
G
G
Valente
U
U
D000328:Adult; D002446:Celiac Disease / Q000150:complications / Q000601:surgery; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D016031:Liver Transplantation / Q000379:methods; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000209:etiology