title: Successful management of a ruptured mycotic pseudoaneurysm following pancreas transplantation using bovine pericardial patch: a case report.
abstract: Arterial mycotic pseudoaneurysms are a rare complication of pancreas transplantation. Rupture results in catastrophic hemorrhage with a high risk of mortality. Definitive management is complicated by an extensive arterial defect within a contaminated surgical field. Synthetic vascular grafts often fail due to subsequent graft infection whereas primary repair often results in arterial stenosis. Arterial ligation may be required to prevent exsanguination. A 41-year-old man, type 1 diabetic with associated renal failure, underwent successful simultaneous pancreas and kidney transplantation. He presented, 9 months following transplantation, with life-threatening rectal bleeding secondary to a ruptured mycotic pseudoaneurysm. This was successfully managed with a bovine pericardial patch (BPP) repair of the arterial defect and enteric diversion following graft pancreatectomy. He remains well with no vascular insufficiency 18 months following the procedure. A ruptured mycotic pseudoaneurysm following transplantation carries a significant risk of mortality and represents a surgical challenge as conventional techniques using synthetic materials often fail due to the contaminated field. A BPP offers good handling characteristics, excellent hemostatic properties and a favorable profile of infection risk in comparison with synthetic grafts. This case highlights its use as a treatment for a post-transplantation ruptured mycotic pseudoaneurysm.
authors.affiliation: Department of Transplantation, Manchester Royal Infirmary, Manchester, United Kingdom; Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Manchester, United Kingdom. Electronic address: py6221@yahoo.co.uk.
authors.forename: P
authors.initials: P
authors.lastname: Yiannoullou
authors.affiliation: Department of Transplantation, Manchester Royal Infirmary, Manchester, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: van Dellen
authors.affiliation: Department of Transplantation, Manchester Royal Infirmary, Manchester, United Kingdom.
authors.forename: H
authors.initials: H
authors.lastname: Khambalia
authors.affiliation: Department of Transplantation, Manchester Royal Infirmary, Manchester, United Kingdom.
authors.forename: B
authors.initials: B
authors.lastname: Forgacs
authors.affiliation: Department of Transplantation, Manchester Royal Infirmary, Manchester, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Tavakoli
authors.affiliation: Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Manchester, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Murray
authors.affiliation: Department of Transplantation, Manchester Royal Infirmary, Manchester, United Kingdom.
authors.forename: T
authors.initials: T
authors.lastname: Augustine
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D000785:Aneurysm, Infected / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D000818:Animals; D001807:Blood Vessel Prosthesis; D002417:Cattle; D006801:Humans; D017543:Iliac Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D016035:Pancreas Transplantation / Q000009:adverse effects*; D010496:Pericardium / Q000637:transplantation; D058017:Vascular Grafting