title: Intestinal obstruction due to internal hernia following pancreas transplantation.
abstract: BACKGROUND
  Simultaneous pancreas-kidney transplantation has evolved as the best treatment for type 1 diabetic patients at end-stage renal disease. The surgical complication rate is high, which is an important barrier to the success of this procedure. The frequent complications that require relaparotomies include fistulas, graft thromboses, and intra-abdominal abscesses. Intestinal obstructions after pancreas transplantation due to internal herniation are not common.
  
  
  OBJECTIVE
  The objective of this article was to review the literature about this problem and describe our personal experience in pancreas transplantation.
  
  
  METHODS
  We examined the cases of small bowel obstruction secondary to an internal hernia after following 292 pancreas transplantations in our center from 2000 to 2009 as well as performed a Medline literature review.
  
  
  RESULTS
  Only 2 articles described the diagnosis and treatment of internal hernias after pancreas transplantation. However, both contribution were from the same center reporting the same 3 cases, with surgical versus radiologic perspectives. We have described our 2 cases of young pancreas-kidney transplant patients who presented with acute intestinal obstruction due to internal hernia.
  
  
  CONCLUSIONS
  Although internal hernias are rare, they are potentially fatal and difficult to diagnose when they occur after pancreas transplantation. Detection with early surgery demands a high degree of clinical vigilance.
authors.affiliation: Universidade Federal de São Paulo-EPM, São Paulo, Brazil. marcelo@gastroenterologie.com.br
authors.forename: M M
authors.initials: MM
authors.lastname: Linhares
authors.forename: L
authors.initials: L
authors.lastname: del Grande
authors.forename: A
authors.initials: A
authors.lastname: Gonzalez
authors.forename: F P
authors.initials: FP
authors.lastname: Vicentine
authors.forename: A
authors.initials: A
authors.lastname: Salzedas
authors.forename: E B
authors.initials: EB
authors.lastname: Rangel
authors.forename: E
authors.initials: E
authors.lastname: Rangel
authors.forename: J R
authors.initials: JR
authors.lastname: Sá
authors.forename: C
authors.initials: C
authors.lastname: Melaragno
authors.forename: M G
authors.initials: MG
authors.lastname: Souza
authors.forename: D
authors.initials: D
authors.lastname: Matos
authors.forename: G J
authors.initials: GJ
authors.lastname: Lopes-Filho
authors.forename: J O Medina
authors.initials: JO
authors.lastname: Pestana
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000209:etiology / Q000601:surgery; D017809:Fatal Outcome; D046449:Hernia, Abdominal / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D016035:Pancreas Transplantation / Q000009:adverse effects*; D016896:Treatment Outcome