کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
5732528 1612076 2017 4 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Case ReportDelayed graft duodenal perforation due to impacted food five years after simultaneous pancreas-kidney transplantation: A case report
ترجمه فارسی عنوان
گزارش مورد گزارش شده پرفوراسیون دوازدهه گلو پیوندی به علت مواد غذایی مضر پنج سال پس از پیوند لوزالمعده و کلیه: گزارش مورد
کلمات کلیدی
پیوند پانکراس، سوراخ شدن پیوند دوازدهه به تاخیر افتاد، رد مزمن، گزارش مورد،
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی عمل جراحی
چکیده انگلیسی


- 75% of pancreas transplantation is SPKT.
- The optimal surgical management for graft perforation is still unknown.
- Delayed graft duodenal perforation is very rare.
- The omega loop may contribute to increased pressure by luminal congestion.
- When delayed duodenal graft perforation occurs, graft excision may not be necessary.

IntroductionPancreas transplantation is the best treatment option in selected patients with type 1 diabetes mellitus. Here we report a patient with a nonmarginal duodenal perforation five years after a simultaneous pancreas-living donor kidney transplantation (SPLKT).Presentation of caseA 31-year old male who underwent SPLKT five years previously presented with severe abdominal pain. He had a marginal duodenal perforation four years later, treated by primary closure and drainage. Biopsy of the pancreas and duodenum graft at that time showed chronic rejection in the pancreas and acute inflammation with an ulcer in the duodenum. At presentation, computerized tomography scan showed mesenteric pneumatosis with enteric leak and ileal dilatation proximal to the anastomotic site. We performed emergent laparotomy and found a 1.0 cm perforation at the nonmarginal, posterior wall of the duodenum. Undigested fiber-rich food was extracted from the site and an omental patch placed over the perforation. An ileostomy was created proximal to the omega loop for decompression and a drain placed nearby. The postoperative course was unremarkable.DiscussionThere are only eight previous cases of graft duodenal perforation in the literature. Fiber-rich food residue passing through the anastomosis with impaction may have led to this perforation.ConclusionWhen a patient is stable, even in the presence of delayed duodenal graft perforation, graft excision may not be necessary. Intraoperative exploration should include Doppler ultrasound examination of the vasculature to rule out thrombosis as a contributor to ischemia. Tissue biopsy should be performed to diagnose rejection.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: International Journal of Surgery Case Reports - Volume 38, 2017, Pages 69-72
نویسندگان
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