title: Case report: pancreas graft with a duodenal complication rescued using total duodenectomy.
abstract: Simultaneous pancreas-kidney (SPK) transplantation is the treatment of choice for type 1 diabetics with end-stage renal disease. Recently patients with type 2 diabetes have been considered for transplantation. Despite that the patient and graft survival rates have improved over the past years, it continues to be a procedure with high surgical complication rates. We herein report a case of a pancreatic graft with a duodenal complication rescued using a total duodenectomy, a procedure that is seldom used. A 57-year-old type 2 diabetic underwent a SPK transplantation with systemic-enteric drainage. He was converted to a Roux en Y at day 7 for a small duodenal fistula without peritonitis. At day 13, with good graft function, he presented with gastrointestinal and abdominal bleeding. At laparotomy he had a congestive duodenum with intraluminal bleeding and an anastomotic fistula. We performed a total duodenectomy with enteric drainage. The patient was discharged home on day 39 with a pancreatic fistula on intramuscular Octretotide that lasted for 3 months. He was never readmitted and has good pancreas and kidney function at 16 months of follow-up. We think this is an option to rescue a pancreas graft with duodenal complications in selected cases.
authors.affiliation: Departamento de Trasplante Renopancreático, Instituto de Nefrología de Buenos Aires - Nephrology, Cabello 3889 (1425), Buenos Aires, Argentina. Electronic address: paduva@yahoo.com.
authors.forename: P D
authors.initials: PD
authors.lastname: Uva
authors.affiliation: Departamento de Trasplante Renopancreático, Instituto de Nefrología de Buenos Aires - Nephrology, Cabello 3889 (1425), Buenos Aires, Argentina.
authors.forename: S
authors.initials: S
authors.lastname: Villavicencio Fornaciari
authors.affiliation: Departamento de Trasplante Renopancreático, Instituto de Nefrología de Buenos Aires - Nephrology, Cabello 3889 (1425), Buenos Aires, Argentina.
authors.forename: A E
authors.initials: AE
authors.lastname: Giunippero
authors.affiliation: Departamento de Trasplante Renopancreático, Instituto de Nefrología de Buenos Aires - Nephrology, Cabello 3889 (1425), Buenos Aires, Argentina.
authors.forename: I C
authors.initials: IC
authors.lastname: Cabrera
authors.affiliation: Departamento de Trasplante Renopancreático, Instituto de Nefrología de Buenos Aires - Nephrology, Cabello 3889 (1425), Buenos Aires, Argentina.
authors.forename: D H
authors.initials: DH
authors.lastname: Casadei
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D004322:Drainage / Q000379:methods; D004386:Duodenum / Q000601:surgery*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects; D011183:Postoperative Complications / Q000601:surgery