title: Early and late presentations of graft arterial pseudoaneurysm following pancreatic transplantation.
abstract: BACKGROUND
  Graft pseudoaneurysm (PSA) following pancreatic transplantation (PT) is a rarely reported complication that has significant morbidity and mortality. Few case reports and small series of this complication exist.
  
  
  METHODS
  Retrospective review of files of 106 patients who underwent PT at the Tel-Aviv Sourasky Medical center between 1995 and 2010. Accessible asymptomatic patients (n = 35) were referred for graft PSA screening using ultrasound-Doppler.
  
  
  RESULTS
  Eight patients developed graft PSA (8 %). All had early posttransplant sepsis. PSA incidence among patients who had perioperative sepsis is 13 %. Three patients developed early postoperative PSA, presenting as massive abdominal bleeding requiring urgent laparotomy and graft resection. Five patients were diagnosed with late-onset graft PSA between 3 months and 11 years posttransplant: clinical presentations were massive gastrointestinal bleeding (n = 2), acute renal failure (n = 1), and asymptomatic finding on screening ultrasound-Doppler (n = 2, 6 % of screened patients).
  
  
  CONCLUSIONS
  PSA following PT occurs in 8 % of patients. Perioperative infection is a risk factor. Early PSAs present as massive intra-abdominal bleeding. PSA may develop years posttransplant, may be asymptomatic, but late rupture is possible and presents as gastrointestinal bleeding. We recommend screening of patients at risk with ultrasound Doppler for early detection and treatment of asymptomatic PSAs.
authors: Department of Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel. nir_lubezky@hotmail.com
authors: Nir
authors: N
authors: Lubezky
authors: Yaacov
authors: Y
authors: Goykhman
authors: Richard
authors: R
authors: Nakache
authors: Ada
authors: A
authors: Kessler
authors: Roni
authors: R
authors: Baruch
authors: Paulina
authors: P
authors: Katz
authors: Itzhak
authors: I
authors: Kori
authors: Joseph M
authors: JM
authors: Klausner
authors: Menahem
authors: M
authors: Ben-Haim
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D016035:Pancreas Transplantation; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D012189:Retrospective Studies; D018608:Ultrasonography, Doppler