Hemostasis caused by stent-graft insertion followed by graft removal for pancreas graft bleeding due to chronic rejection: A case report

Q4 Medicine
Kohei Miura , Takashi Kobayashi , Hirosuke Ishikawa , Seiji Saito , Yasuo Obata , Yohei Miura , Koji Toge , Yuki Hirose , Taku Ohashi , Kazuyasu Takizawa , Jun Sakata , Masayuki Tasaki , Kazuhide Saito , Yoshihiko Tomita , Toshifumi Wakai
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引用次数: 0

Abstract

Introduction

Lethal symptoms due to graft rejection warrant rapid removal of the transplanted graft to save the patient's life. We report a case of massive pancreas graft bleeding due to chronic rejection that necessitated graft removal after hemostasis by stent graft insertion.

Case presentation

A 39-year-old woman underwent simultaneous pancreas-kidney transplantation for type I diabetes and chronic renal failure nine years ago. She suffered irreversible kidney damage from severe chronic rejection due to drug non-compliance. She was admitted to the emergency department for abdominal pain and bloody stools. She presented with signs of shock based on her vitals due to massive bleeding in the stool a day after hospitalization and required systemic management in the intensive care unit (ICU). Enhanced computed tomography (CT) scan revealed active bleeding from the duodenal portion of the pancreas graft. Hemostasis was achieved by inserting a stent graft into the right external iliac artery. The respiratory and circulatory status of the patient improved after the intervention, and she was transported to our hospital day after treatment. The graft was removed along with the part of the anastomosed intestine, which was reconstructed with a functional end-to-end anastomosis.

Conclusion

We encountered a patient with hemorrhagic shock due to bleeding from a rejected pancreas graft. The patient was successfully treated and saved using stent-graft hemostasis followed by graft removal. Clinicians and surgeons should be mindful of chronic rejection, which could lead to life-threatening hemodynamic complications.

慢性排斥反应导致胰腺移植出血,植入支架后取出支架止血1例
移植排斥反应引起的致命症状需要迅速切除移植的移植物以挽救患者的生命。我们报告一例胰脏移植物因慢性排斥反应而大出血,需要在植入术止血后取出移植物。病例介绍:一名39岁女性,9年前因1型糖尿病和慢性肾衰竭接受了胰肾联合移植手术。由于药物不遵医嘱,她遭受了严重的慢性排斥反应,造成了不可逆的肾脏损害。她因腹痛和便血被送进急诊科。住院一天后,患者因大出血出现休克体征,需要在重症监护病房(ICU)进行全身治疗。增强计算机断层扫描(CT)显示活动性出血从十二指肠部分的胰腺移植。止血是通过在右髂外动脉内植入支架实现的。干预后患者呼吸循环状况好转,治疗后第1天送至我院。将移植物与吻合的部分肠一起移除,用功能性端到端吻合术重建。结论我们收治了一例因胰腺移植排斥出血而发生失血性休克的患者。通过支架-移植物止血和移植物切除,患者得到了成功的治疗和挽救。临床医生和外科医生应注意慢性排斥反应,这可能导致危及生命的血流动力学并发症。
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来源期刊
Transplantation Reports
Transplantation Reports Medicine-Transplantation
CiteScore
0.60
自引率
0.00%
发文量
24
审稿时长
101 days
期刊介绍: To provide to national and regional audiences experiences unique to them or confirming of broader concepts originating in large controlled trials. All aspects of organ, tissue and cell transplantation clinically and experimentally. Transplantation Reports will provide in-depth representation of emerging preclinical, impactful and clinical experiences. -Original basic or clinical science articles that represent initial limited experiences as preliminary reports. -Clinical trials of therapies previously well documented in large trials but now tested in limited, special, ethnic or clinically unique patient populations. -Case studies that confirm prior reports but have occurred in patients displaying unique clinical characteristics such as ethnicities or rarely associated co-morbidities. Transplantation Reports offers these benefits: -Fast and fair peer review -Rapid, article-based publication -Unrivalled visibility and exposure for your research -Immediate, free and permanent access to your paper on Science Direct -Immediately citable using the article DOI
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