title: Management of Graft Duodenal Leak in Simultaneous Pancreas Kidney Transplant-a Case Report from India and Review of Literature.
abstract: Pancreatic transplantation is currently the only effective cure for Type 1 diabetes mellitus. It allows long-term glycemic control without exogenous insulin and amelioration of secondary diabetic complications. In India, pancreas transplant has not yet established with only a single successful transplant reported so far in the literature. We report a 24-year-old Type 1 diabetic patient with renal failure who underwent a simultaneous pancreas kidney transplant. On postoperative day 15, he had leak from the graft duodenal stump for which a tube duodenostomy and proximal diversion enterostomy was done. He had a high output pancreatic fistula following the procedure which was managed conservatively. The tube duodenostomy was removed at three and half months and enterostomy closure with restoration of bowel continuity was done at 6 months. After a follow up of 7 months, patient is doing well with a serum creatinine of 0.8 mg/dl and normal blood sugars, not requiring any exogenous insulin or oral hypoglycemic drugs. Managing patients with graft duodenal complications after pancreas transplant is challenging. Tube duodenostomy is a safe option in management of duodenal leak, although can lead to a persistent pancreatic fistula. A proximal diversion enterostomy allows early oral feeding and avoids the cost as well as the long term complications associated with parenteral nutrition.
authors.affiliation: Department of Renal Transplant Surgery, Post graduate institute of medical education and research, Chandigarh, 160012 India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Renal Transplant Surgery, Post graduate institute of medical education and research, Chandigarh, 160012 India.
authors.forename: Sarbpreet
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Renal Transplant Surgery, Post graduate institute of medical education and research, Chandigarh, 160012 India.
authors.forename: Deepesh Benjamin
authors.initials: DB
authors.lastname: Kenwar
authors.affiliation: Department of Nephrology, Post graduate institute of medical education and research, Chandigarh, 160012 India.
authors.forename: Manish
authors.initials: M
authors.lastname: Rathi
authors.affiliation: Department of Endocrinology, Post graduate institute of medical education and research, Chandigarh, 160012 India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Bhadada
authors.affiliation: Department of Renal Transplant Surgery, Post graduate institute of medical education and research, Chandigarh, 160012 India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of General Surgery, Post graduate institute of medical education and research, Chandigarh, 160012 India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Department of Endocrinology, Post graduate institute of medical education and research, Chandigarh, 160012 India.
authors.forename: Anil
authors.initials: A
authors.lastname: Bhansali
authors.affiliation: Department of Radiodiagnosis, Post graduate institute of medical education and research, Chandigarh, 160012 India.
authors.forename: Anupam
authors.initials: A
authors.lastname: Lal
authors.affiliation: Department of Renal Transplant Surgery, Post graduate institute of medical education and research, Chandigarh, 160012 India.
authors.forename: Mukut
authors.initials: M
authors.lastname: Minz
keywords: Complications after transplantation; Duodenal leak; Simultaneous pancreas kidney transplant; Type 1 diabetes mellitus