Higgins Peter D R, Umar Ramsey K, Parker Jennifer R, DiMagno Matthew J
Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, MI 48109, USA.
Nat Clin Pract Gastroenterol Hepatol. 2005 May;2(5):240-4; quiz 1 p following 244. doi: 10.1038/ncpgasthep0175.
This article highlights two cases of massive lower gastrointestinal bleeding in patients on dialysis after rejection of kidney-pancreas transplants. Patient 1 was a 34-year-old female with 27 years of type I diabetes, who had a kidney-pancreas transplant in 1996, which was complicated by rejection of the kidney and pancreas in 2000 and 2002, respectively. Later in 2002, she presented in shock after experiencing cramping abdominal pain and passage of large bloody stools. Patient 2 was a 38-year-old male with 26 years of type I diabetes, who had a pancreas-kidney transplant in 1998, which was complicated by rejection of the kidney and pancreas in early 2003. He presented in late 2003 with a single episode of coffee-ground emesis and two episodes of brisk hematochezia.
Arterial angiography.
Pseudoaneurysm and small-bowel fistula from the arterial supply to the transplanted pancreas.
Angiographic embolization of the aneurysmal vessel and fistula achieved hemostasis. Patient 1 did not have her transplanted organ surgically removed and suffered a recurrent massive lower gastrointestinal bleed that proved fatal. In Patient 2, subsequent surgery and removal of the rejected pancreas was performed and the patient continues to do well.
本文重点介绍了两例肾胰腺移植排斥后接受透析治疗的患者发生大量下消化道出血的病例。患者1为一名34岁女性，患I型糖尿病27年，1996年接受肾胰腺移植，2000年和2002年分别出现肾和胰腺排斥反应。2002年晚些时候，她在经历腹部绞痛和排出大量血便后出现休克。患者2为一名38岁男性，患I型糖尿病26年，1998年接受胰肾移植，2003年初出现肾和胰腺排斥反应。他在2003年末出现一次咖啡渣样呕吐物和两次鲜红色便血。
动脉血管造影。
移植胰腺动脉供血处假性动脉瘤和小肠瘘。
对动脉瘤血管和瘘进行血管造影栓塞实现止血。患者1未进行移植器官手术切除，再次发生大量下消化道出血，最终死亡。患者2随后接受手术并切除排斥的胰腺，目前情况良好。
