Gastrointestinal bleeding in a pancreas transplant recipient: A case to remember

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Abstract

Background: Pancreas transplantation has proven to be the most effective therapeutic option for insulin-dependent diabe-tes mellitus. However, despite advances in surgical technique and continuously improving outcomes, pancreas transplantation has the highest complication rate among all solid-organ transplants. Vascular complications in particular can be catastrophic, with graft-and life-threatening potential. Ectopic variceal bleeding is less common and is rarely reported in the literature. Case Report: A 51-year-old man presented with recurrent intermittent gastrointestinal bleeding (GIB) associated with he-patic dysfunction and portal hypertension 4 years after a successful pancreas-after-kidney transplant. Apart from positive serology for hepatitis E virus, all the other liver disease screening results were negative. He was extensively investigated with 6 computed tomography (CT) scans, 3 esophago-gastro-duodenoscopies (EGD), 3 colonoscopies, and 1 visceral arteriogram before the plausible diagnosis of ectopic trans-anastomotic varice-al bleeding involving the pancreas transplant was established. Selective variceal catheterization and emboliza-tion were done with 3% sodium tetradecyl sulphate (STD). He remained free of bleeding after embolization. Conclusions: This case report adds to the scanty literature on the management of ectopic variceal bleeding in a pancreas transplant recipient. Diagnosis of ectopic varix is usually challenging and frequently requires a visceral arte-riogram. We describe a novel minimally-interventional technique to obtain source control and also discuss the complexity involved in the management, along with future implications.

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Gopal, J. P., Jackson, J. E., Palmer, A., Taube, D., & Rathnasamy Muthusamy, A. S. (2020). Gastrointestinal bleeding in a pancreas transplant recipient: A case to remember. American Journal of Case Reports, 21, 1–5. https://doi.org/10.12659/AJCR.923197

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