Divisione di Chirurgia Generale e Trapianti nell'Uremico e nel Diabetico, Ospedaliera-Universitaria Pisana, Pisa, Italy.
Am J Transplant. 2010 Mar;10(3):692-7. doi: 10.1111/j.1600-6143.2009.02981.x. Epub 2010 Jan 29.
Duodenal graft complications (DGC) occur frequently after pancreas transplantation but rarely cause graft loss. Graft pancreatectomy, however, may be required when DGC compromise recipient's safety. We herein report on two patients with otherwise untreatable DGC in whom the entire pancreas was salvaged by means of total duodenectomy with enteric drainage of both pancreatic ducts. The first patient developed recurrent episodes of enteric bleeding, requiring hospitalization and blood transfusions, starting 21 months after transplantation. The disease causing hemorrhage could not be defined, despite extensive investigations, but the donor duodenum was eventually identified as the site of bleeding. The second patient was referred to us with a duodenal stump leak, 5 months after transplantation. Two previous surgeries had failed to seal the leak, despite opening a diverting stoma above the duodenal graft. Thirty-nine and 16 months after total duodenectomy with dual duct drainage, respectively, both patients are insulin-independent and free from abdominal complaints. Magnetic resonance pancreatography shows normal ducts both basal and after intravenous injection of secretin. The two cases presented herein show that when DGC jeopardize pancreas function or recipient safety, total duodenectomy with enteric duct drainage may become an option.
十二指肠移植物并发症（DGC）在胰腺移植后经常发生，但很少导致移植物丢失。然而，当 DGC 危及受者安全时，可能需要进行移植物胰切除术。本文报告了两例 otherwise untreatable DGC 患者，通过全十二指肠切除术和胰管肠内引流成功挽救了整个胰腺。第一例患者在移植后 21 个月开始反复出现肠出血，需要住院和输血。尽管进行了广泛的检查，但仍无法确定导致出血的原因，但最终确定供体十二指肠是出血部位。第二例患者在移植后 5 个月因十二指肠残端漏而转来我院。尽管在十二指肠移植物上方开了一个旁路造口以封闭漏口，但两次先前的手术均未成功。全十二指肠切除术加双管引流后 39 个月和 16 个月，两名患者均无需胰岛素且无腹部不适。磁共振胰胆管造影显示基础和静脉注射缩胆囊素后胰管均正常。本文报告的两例病例表明，当 DGC 危及胰腺功能或受者安全时，全十二指肠切除术加肠内引流可能成为一种选择。
