Fumimoto Yuichi, Tanemura Masahiro, Hoshida Yoshihiko, Nishida Toshirou, Sawa Yoshiki, Ito Toshinori
Department of Surgery (E1), Osaka University Graduate School of Medicine, Suita, Japan.
Case Rep Gastroenterol. 2008 Jul 24;2(2):244-9. doi: 10.1159/000136017.
Although complications including graft thrombosis, graft pancreatitis, and rejection have been well documented after pancreas transplantation, the occurrence of graft duodenal perforation is uncommon. In this article, we report a case of graft duodenal perforation due to internal hernia after simultaneous pancreas-kidney transplantation (SPK). A patient with type I diabetes mellitus and diabetic nephropathy had undergone SPK from a cadaveric donor. One year later, she was admitted to our hospital for severe lower abdominal pain with preshock status. She was immediately examined by abdominal computed tomography and both peripancreas graft fluid accumulation and severe dilatation of the ileum were detected. On emergency operation, two punched holes located at the graft duodenal side near the suture line and an obstruction of herniated bowel behind the graft pancreas were detected. These holes were repaired and the internal hernia was reduced. However, a control of the intraabdominal infection was very difficult despite intensive treatment with antibiotics and additional abdominal drainage. Finally, a graft pancreatectomy was unavoidably required. When complications, including symptomatic intraabdominal infection, require re-laparotomy after pancreas transplantation, the therapeutic focus should be switched from salvaging the graft to the preservation of life.
尽管胰腺移植后包括移植血管血栓形成、移植胰腺胰腺炎和排斥反应等并发症已有充分记录，但移植十二指肠穿孔的发生并不常见。在本文中，我们报告了一例在胰肾联合移植（SPK）后因内疝导致移植十二指肠穿孔的病例。一名患有I型糖尿病和糖尿病肾病的患者接受了来自尸体供体的SPK手术。一年后，她因严重下腹痛并处于休克前期状态入住我院。立即对其进行腹部计算机断层扫描检查，发现胰周移植液积聚和回肠严重扩张。在急诊手术中，发现移植十二指肠侧靠近缝合线处有两个穿孔，且移植胰腺后方有疝入肠管梗阻。修复了这些穿孔并还纳了内疝。然而，尽管使用抗生素进行了强化治疗并增加了腹腔引流，但腹腔内感染的控制仍然非常困难。最后，不可避免地需要进行移植胰腺切除术。当胰腺移植后出现包括有症状的腹腔内感染等并发症需要再次剖腹手术时，治疗重点应从挽救移植物转向挽救生命。
