Enteric-drained pancreas transplantations have been increasing [1]. Access to the surgical anastomosis is desirable for monitoring of rejection and
management of bleeding complications. A 34-year-old diabetic man with nephropathy
requiring hemodialysis underwent simultaneous enteric-drained pancreas–kidney transplantation.
On postoperative day 6, he developed hematochezia. Physical examination revealed red
blood in the rectum. The hematocrit declined from 35 % to 23 % within 24 hours. After
volume resuscitation, esophagogastroduodenoscopy and colonoscopy were performed, demonstrating
esophagitis, sigmoid diverticulosis, and old blood. The terminal ileum was evaluated
but the surgical anastomosis was not reached. The next day, hematochezia recurred,
with a drop in hematocrit from 27 % to 23 %. A retrograde single-balloon enteroscopy
(SIFQ180; Olympus Inc., Tokyo, Japan) with a disposable overtube (ST-SB1, Disposable
Sliding Tube; Olympus) was performed. The duodenal stump–ileal anastomosis was reached,
approximately 60 cm proximal to the ileocecal valve, revealing active, spurting bleeding
from a visible vessel within an anastomotic ulcer ([Fig. 1]). Three endoclips (QuickClip2; Olympus) were placed at the bleeding site, with successful
hemostasis ([Fig. 2]). The donor duodenum could be easily visualized ([Fig. 3]). The patient had no further bleeding episodes.
Fig. 1 Actively bleeding anastomotic ulcer.
Fig. 2 Hemostasis with endoclips.
Fig. 3 Donor duodenum.
The use of enteric-drained pancreas transplantation for treatment of diabetes mellitus
has been limited by the frequent occurrence of complications. Repeat laparotomy is
required in up to 37 % of patients within 3 months of operation [1]. Anastomotic ulcers have been reported in 11.5 % of patients; the risk is higher
for the Roux technique [2]. Angiography may be implemented to manage such bleeding complications [3], but contrast nephropathy remains a risk. The single-balloon system was developed
as an alternative to explore the small intestine [4]. This technique is particularly attractive because it can assess areas of the small
intestine not evaluated by standard endoscopic instruments. Single-balloon enteroscopy
may be used for monitoring pancreas rejection and management of postoperative anastomotic
bleeding.
Endoscopy_UCTN_Code_TTT_1AP_2AD
