title: Duodenum-stomach anastomosis: a new technique for exocrine drainage in pancreas transplantation.
abstract: BACKGROUND
  Poor vascular access due to previous surgery can be a major obstacle in pancreas transplantation for which new exocrine and vascular outflow techniques might be useful. A 34-year-old female with early onset type 1 diabetes who underwent living donor kidney transplantation 20 years ago and a failed pancreas transplantation 2 years ago presented for pancreas retransplantation.
  
  
  METHODS
  The inferior vena cava was used in the previous deceased donor pancreas transplantation and both iliac arteries had intense perivascular fibrosis, making arterial anastomosis impossible. The only remaining option for the implant was the infrarenal aorta, with venous drainage to the superior mesenteric vein and exocrine drainage to the gastric antrum.
  
  
  RESULTS
  The patient had an uneventful recovery and graft function appeared normal. This report shows that when the recipient's abdominal cavity does not provide clear access for the usual surgical techniques regarding exocrine drainage, the stomach drainage procedure is an option.
  
  
  CONCLUSIONS
  Duodenum-stomach anastomosis might be an alternative to portal enteric drainage because there is easy access for graft biopsies and even for procedures involving the papilla major.
authors.affiliation: Department of Surgery, Federal University of Sao Paulo, São Paulo, Brazil. marbet@uol.com.br
authors.forename: Marcelo Moura
authors.initials: MM
authors.lastname: Linhares
authors.forename: Reinaldo Isaacs
authors.initials: RI
authors.lastname: Beron
authors.forename: Adriano Miziara
authors.initials: AM
authors.lastname: Gonzalez
authors.forename: Cristian
authors.initials: C
authors.lastname: Tarazona
authors.forename: Alcides
authors.initials: A
authors.lastname: Salzedas
authors.forename: Erika B
authors.initials: EB
authors.lastname: Rangel
authors.forename: Erika
authors.initials: E
authors.lastname: Rangel
authors.forename: Joao Roberto
authors.initials: JR
authors.lastname: Sá
authors.forename: Claudio
authors.initials: C
authors.lastname: Melaragno
authors.forename: Suzan Menasce
authors.initials: SM
authors.lastname: Goldman
authors.forename: Marcelo Gonçalves
authors.initials: MG
authors.lastname: Souza
authors.forename: Nelson Y
authors.initials: NY
authors.lastname: Sato
authors.forename: Delcio
authors.initials: D
authors.lastname: Matos
authors.forename: Gaspar Jesus
authors.initials: GJ
authors.lastname: Lopes-Filho
authors.forename: Jose Osmar
authors.initials: JO
authors.lastname: Medina
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D004322:Drainage / Q000379:methods*; D004386:Duodenum / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000601:surgery; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods; D019520:Living Donors; D016035:Pancreas Transplantation / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D012086:Reoperation / Q000379:methods; D013270:Stomach / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome