El-Arabi Ahmad M, Pittman Stephen P, Dekonenko Charlene, Locke Nathan J, Duchene David A
Department of Urology, University of Kansas Health System, Kansas City, Kansas, USA.
Department of Surgery, University of Kansas Health System, Kansas City, Kansas, USA.
J Endourol Case Rep. 2020 Dec 29;6(4):249-252. doi: 10.1089/cren.2020.0042. eCollection 2020.
Historically, exocrine pancreas secretions during pancreas transplant were commonly managed by bladder drainage. Although this technique has fallen out of favor because of significant rates of urologic complications, urologists must still be prepared to assist when they arise. We describe the first reported case of a cystoscopically placed pancreatic duct stent for management of a pancreas transplant duodenocystostomy leak in the setting of normal bladder function. A 63-year-old male with a history of type 1 diabetes mellitus complicated by end-stage renal disease underwent a simultaneous bladder-drained pancreas and kidney transplant 25 years ago. He developed hematuria and acute rejection of his pancreas, with CT showing large volume ascites concerning for pancreatic leak. Cystoscopy revealed an intact and patent duodenal-cystostomy anastomosis; however, intraperitoneal extravasation on intraoperative cystogram raised concern for pancreatic head necrosis. The patient underwent intraperitoneal drain placement and Foley catheter bladder decompression, but drain output and drain amylase and lipase remained markedly elevated. He was taken back to the operating room for attempted cystoscopic stenting of the pancreatic duct, which was effective using a 5F × 4 cm Zimmon pancreatic stent. His drain output normalized in the following days and the pancreatic stent and intraperitoneal drain were removed 4 and 5 weeks after discharge, respectively. Outpatient urodynamics revealed no signs of obstruction and his catheter was removed with minimal postvoid residuals on follow-up. Anastomotic leak after duodenocystostomy during pancreas transplant is a complication typically related to elevated intravesical pressures, managed with bladder decompression and subsequent bladder outlet procedure. We present a novel technique for cystoscopic pancreatic duct stenting in the setting of intact anastomosis and normal bladder function with delayed leak secondary to necrotic pancreatic head. Endoscopic stent placement, intraperitoneal drainage, and bladder decompression with Foley catheter are an effective technique to avoid unnecessary reconstructive surgery.
从历史上看，胰腺移植期间外分泌胰腺的分泌物通常通过膀胱引流来处理。尽管由于泌尿系统并发症发生率较高，这种技术已不再受欢迎，但泌尿科医生在并发症出现时仍必须做好协助准备。我们描述了首例经膀胱镜置入胰管支架治疗胰腺移植十二指肠膀胱吻合口漏且膀胱功能正常的病例。一名63岁男性，有1型糖尿病病史并伴有终末期肾病，25年前同时接受了膀胱引流的胰腺和肾脏移植。他出现了血尿和胰腺急性排斥反应，CT显示大量腹水，怀疑有胰腺漏。膀胱镜检查显示十二指肠 - 膀胱吻合口完整且通畅；然而，术中膀胱造影显示腹腔内有造影剂外渗，令人担心胰头坏死。患者接受了腹腔引流管置入和留置导尿管膀胱减压，但引流液量以及引流液中的淀粉酶和脂肪酶水平仍明显升高。他被带回手术室尝试通过膀胱镜对胰管进行支架置入，使用5F×4cm的Zimmon胰管支架取得了成功。接下来几天他的引流液量恢复正常，出院后4周和5周分别拔除了胰管支架和腹腔引流管。门诊尿动力学检查未发现梗阻迹象，随访时拔除导尿管后残余尿量极少。胰腺移植期间十二指肠膀胱吻合口漏是一种通常与膀胱内压力升高相关的并发症，通过膀胱减压及随后的膀胱出口手术进行处理。我们介绍了一种在吻合口完整、膀胱功能正常且因胰头坏死导致延迟漏的情况下，经膀胱镜置入胰管支架的新技术。内镜下支架置入、腹腔引流以及用留置导尿管进行膀胱减压是避免不必要的重建手术的有效技术。
