Cure ofpancreaticoduodenal anastomotic leakage after simultaneous pancreas-kidney transplantation with enteric drainage: a case report and literature review

Abstract

Objective To summarize the experience of one case of anastomotic leakage after simultaneous pancreas-kidney transplantation (SPK) with enteric drainage. Methods One case of type 2 diabetes mellitus complicated with end-stage nephropathy undergoing SPK was retrospectively analyzed. Iliac venous systemic circulation was employed for pancreatic venous reflux, transplanted pancreas exocrine via enteric drainage and side-to-side anastomosis between donor pancreaticoduodenum and recipient jejunum. Pancreatoduodenal anastomotic leakage occurred at 12 days post-operation. During re-operation, Roux-en-Y anastomosis was established between donor pancreaticoduodenum and recipient jejunum. And the relevant domestic and foreign literatures were searched. Results The follow-up time was 3 month after a second operation. Recipient pancreas and kidney transplantation survived well. There was no onset of enteric leakage. The incidence of anastomotic leakage varies greatly between different transplantation centers both at home and abroad. The incidence ranged from 3.6% to 11.3%. And the risk of pancreatic loss was as high as 54.6%. Conclusions As a severe postoperative complication, anastomotic fistula after SPK may cuase abdominal infection. Even after reparing enteric fistula, the risk of leakage remains high. Roux-en-Y anastomosis is other therapeutic option. Key words: Simultaneous pancreas and kidney transplantation; Pancreas graft; Duodenum graft; Anastomotic leakage