Kovács Dávid Ágoston, Al Huurman Volkert, Wojcicki Maciej, Soonowala Darius, Baranski Andrzej
From the Leiden University Medical Centre, Department of Surgery, Division of Transplantation, Hungary.
Exp Clin Transplant. 2018 Aug;16(4):499-501. doi: 10.6002/ect.2016.0028. Epub 2016 Jul 22.
Simultaneous pancreas-kidney transplant is currently standard therapy to achieve long-term insulin-free euglycemia in patients with type 1 diabetes mellitus and concomitant end-stage kidney failure. A patient with symptoms of encephalopathy caused by hyperammonemia and with new-onset iron deficiency anemia was admitted to our institution 20 months after a simultaneous pancreas-kidney transplant. Detailed screening did not reveal any specific cause for the hyperammonemia, and despite standard treatment, hyperammonemia did not resolve. An abdominal computed tomographic scan was performed, which showed a distended duodenal segment of the pancreas graft. This was confirmed during exploratory laparotomy when the anastomosis between duodenum and ileum was dismantled and found not to be stenotic. The excessively long stumps of the duodenum were then dissected and shortened, and a new anastomosis between graft-duodenum and recipient-ileum was created. The operation was followed by an uncomplicated postoperative course in which the serum ammonia normalized on the first postoperative day and remained normal afterwards. An excessively long segment of the duodenum of the pancreatic graft may lead to encephalopathy with hyperammonemia after a simultaneous pancreas-kidney transplant. This emphasizes the need for meticulous preparation of the graft to avoid this complication.
同时进行胰腺-肾脏移植是目前实现1型糖尿病合并终末期肾衰竭患者长期无胰岛素正常血糖的标准治疗方法。一名在同时进行胰腺-肾脏移植20个月后出现高氨血症所致脑病症状并伴有新发缺铁性贫血的患者入住我院。详细筛查未发现高氨血症的任何具体病因，尽管进行了标准治疗，但高氨血症仍未缓解。进行了腹部计算机断层扫描，结果显示胰腺移植物的十二指肠段扩张。在剖腹探查术中，当十二指肠与回肠之间的吻合口被拆除并发现无狭窄时，这一点得到了证实。然后将十二指肠过长的残端进行解剖并缩短，并在移植十二指肠与受体回肠之间建立了新的吻合口。术后过程顺利，术后第一天血清氨水平恢复正常，此后一直保持正常。胰腺移植物十二指肠段过长可能导致同时进行胰腺-肾脏移植后出现高氨血症性脑病。这强调了对移植物进行细致准备以避免这种并发症的必要性。
