Gastrointestinal Bleeding Secondary to Iliac Artery Pseudoaneurysm in a Patient With Remote Pancreas Transplant: A Case Report

Nonoperative management of gastrointestinal bleeding after a simultaneous pancreas and kidney transplant

“…More than 48 000 pancreas transplants were performed in the first 30 years after the establishment of the International Pancreas Transplant Registry. [ 1 ] Despite the high volume, pancreas transplants continue to have high complication rates, many of which resulted in subsequent early posttransplant graft loss [ 2 ]. The nature of these complications is directly related to variations in the surgical technique throughout the continued elaboration of pancreas transplants.…”

“…Initially, the most common technique in transplantation was a systemic-bladder technique. This approach allowed for easy monitoring of graft function via urinary amylase and cystoscopy [ 2 ], such as recurrent urinary tract infections, metabolic acidosis, reflux pancreatitis, hematuria, urethritis and urethral strictures [ 3 ]. As these patients were converted to the enteric drainage technique, the popularity of the duodenojejunostomy for enteric drainage began to rise.…”

“…Today, this surgical approach is most commonly used but is associated with a new category of surgical complications [ 2 ]. GI bleeding is a common complication identified postoperatively [ 3 ].…”

“…Distant GI bleeds have been associated with pancreatic-aortic fistulas and pseudoaneurysm rupture [ 4 , 5 ]. Reports of ulcers related to CMV infection have also been reported [ 2 ]. In the immediate postoperative period, GI bleeding has been associated with an ulcer at the duodenal stump and recipient jejunum anastomosis [ 2 ].…”

“…With a shift toward different surgical techniques, the complications associated with SPK have also changed. Gastrointestinal (GI) bleeds are one of the most common complications associated with SPK; however, most of these hemorrhages are associated with ulcers at the duodenojejunostomy anastomosis and also associated with cytomegalovirus (CMV) infection [ 2 ]. Due to the location of this anastomosis, endoscopy is usually not effective in the diagnosis or treatment of these ulcers [ 1 ].…”