Endovascular Management of Acute Enteric Bleeding from Pancreas Transplant

Semiz-Oysu, Aslıhan; Cwikiel, Wojciech

doi:10.1007/s00270-006-0058-z

Cited by 22 publications

(22 citation statements)

References 8 publications

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“…When catastrophic GI bleeding does occur, as detailed in the patient described herein, endovascular embolization and/or endovascular stent placement should be the treatment of choice. Surgical removal of the failed pancreatic allograft should be considered for the best long-term outcomes, since the incidence of rebleeding among these patients can be high [6, 9]. …”

Section: Discussionmentioning

confidence: 99%

Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas Allograft

Desai

Patel

Nwosu

et al. 2013

Case Reports in Transplantation

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We present a case of a patient with a failed pancreaticoduodenal allograft with exocrine enteric-drainage who developed catastrophic gastrointestinal (GI) hemorrhage. Over the course of a week, she presented with recurrent GI bleeds of obscure etiology. Multiple esophago-gastro-duodenoscopic (EGD) and colonoscopic evaluations failed to reveal the source of the hemorrhage. A capsule endoscopy and a technetium-labeled red blood cells (RBC) imaging study were similarly unrevealing for source of bleeding. She subsequently developed hemorrhagic shock requiring emergent superior mesenteric arteriography. Run off images revealed an external iliac artery aneurysm with fistulization into the jejunum. Coiled embolization was attempted but abandoned because of hemodynamic instability. Deployment of a covered endovascular stent into the right external iliac artery over the fistula site resulted in immediate hemodynamic stabilization. A high index of suspicion for arterioenteric fistulae is needed for diagnosis of this uncommon but eminently treatable form of GI hemorrhage in this patient population.

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Section: Discussionmentioning

confidence: 99%

Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas Allograft

Desai

Patel

Nwosu

et al. 2013

Case Reports in Transplantation

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“…The literature reporting arterial complications associated with a pancreatic allograft is sporadic, spanning 1989‐2017. In all, 7 case series and 34 case reports describe 70 patients with arterial complications. As in our series, the majority of complications were in primary pancreatic transplant recipients with enteric drainage.…”

Section: Resultsmentioning

confidence: 99%

Significant arterial complications after pancreas transplantation—A single‐center experience and review of literature

Yadav

Young

Finger

et al. 2017

Clinical Transplantation

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Arterial fistulas and pseudoaneurysms are rarely described significant arterial complications associated with pancreas transplantation that sometimes present with herald or catastrophic bleeding. We herein describe our institutional case series with a focus on management and outcomes. Of 2256 pancreas transplants, 24 arterial complications were identified in 23 recipients. Chart review was performed to describe the clinical characteristics, treatments, and outcomes of the complications (pseudoaneurysm, arterial enteric/cystic/ureteric fistula, or arteriovenous fistula). Of these 23 patients, 57% had a failed allograft at the time of the complication. Nine patients underwent primary surgical repair of 10 complications, 13 were treated by endovascular methods, and one patient by medical management. In total, 3 embolized patients rebled, 2 of which had failed allografts prior to treatment. Of those with graft function that were treated by embolization alone, all retained graft function. Diagnosis of arterial complications requires a high degree of suspicion and should involve early systemic angiography to evaluate the pancreatic vasculature. Management can be endovascular or surgical and should be individualized. We report our center's evolution from a predominantly surgical to endovascular approach as a definitive vs stabilizing therapy, with selective coiling mostly reserved for well-defined peripheral lesions in patients with a functioning allograft.

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“…As proposed by Yadav et al, treatment strategies should be adapted individually for each situation and should take in to account existing graft function. In case of loss of function, pancreatectomy should be considered immediately or after hemodynamic stabilization via endovascular (stenting, embolization) strategies . When the pancreatic function is still present, strategies should be adapted to achieve allograft preservation in case of hemodynamic stability …”

Section: Discussionmentioning

confidence: 99%

“…Primary causes for late bleeding episodes are fistulae (arterioenteric, arterioureteric, arteriocystic, or arteriovenous), pseudoaneurysms, invasive infections, as well as severe rejection episodes . In addition to the vascular anastomoses, the enteric anastomoses are a potential source of bleeding in enterically drained pancreas grafts . We herein investigate the etiology, clinical course, and treatment strategies of late repetitive bleeding episodes originating from the duodenojejunostomy after pancreas transplantation in a large single center cohort.…”

Section: Introductionmentioning

confidence: 99%

Late recurrent bleeding episodes from duodenojejunostomy after pancreas transplantation

Messner

Bösmüller

Oberhuber

et al. 2018

Clinical Transplantation

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In response to a number of late, repetitive bleeding episodes from the site of the enteric anastomosis, we herein analyze the clinical courses and etiologies of 379 consecutively performed pancreas transplants between January 2000 and December 2016. Duodenojejunostomies for enteric drainage were performed at the upper jejunum in a side to side, double layer fashion. Five patients (1.3%) developed recurrent late hemorrhagic episodes originating from the graft duodenal anastomosis. Bleeding from the anastomotic site was associated with hematochezia, hemodynamic instability and decrease in serum hemoglobin. Mean onset was 6.4(±2.8) years after transplantation. Bleeding was recurrent (mean 5.2 ± 2.6) and required 9(±2.5) interventions. Hypervascularization, mucosal vulnerability, and bleeding at the site of the enteric anastomosis could be identified in all cases. In four patients, the enteric pancreas anastomosis was resected and a new duodenojejunostomy was performed. No pancreas graft loss occurred due to bleeding. In two patients, hepatic cirrhosis and portal hypertension were identified, one patient had a liver fibrosis as putative cause for the repetitive bleeding episodes. Late anastomotic hemorrhage is a rare but severe complication following pancreas transplantation. The treatment is challenging and includes endoscopy, interventional radiology, and surgery. Hepatic conditions with an increased portal pressure may be the underlying cause.

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Endovascular Management of Acute Enteric Bleeding from Pancreas Transplant

Cited by 22 publications

References 8 publications

Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas Allograft

Arteriojejunal Fistula Presenting with Recurrent Obscure GI Hemorrhage in a Patient with a Failed Pancreas Allograft

Significant arterial complications after pancreas transplantation—A single‐center experience and review of literature

Late recurrent bleeding episodes from duodenojejunostomy after pancreas transplantation

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