Gastrointestinal Bleeding From Enteric Anastomosis in Simultaneous Pancreas/Kidney Transplantation: A Novel Hybrid Approach.
Javier Chapochnick, Carlos Derosas, Rodrigo Iñiguez et al.
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Case in brief
Two patients developed severe gastrointestinal bleeding from the donor-recipient enteric anastomosis after simultaneous pancreas-kidney transplantation. Because postoperative anatomy can limit endoscopic access, each underwent exploratory laparotomy and a targeted enterotomy to permit intraoperative endoscopy. Endoscopic clips controlled the bleeding while preserving the existing duodenojejunostomy. Neither patient had recurrent bleeding, anastomotic complications, or graft-related adverse events. At 8 and 4 years of follow-up, respectively, both pancreatic and renal grafts remained functional, with no transplant-related rehospitalizations.
What made this case unusual
The hybrid approach provided direct endoscopic access to the bleeding anastomosis through a surgically created enterotomy, enabling clip hemostasis without revising the enteric reconstruction.
Diagnostic / clinical pearl
In selected SPK recipients with enteric anastomotic bleeding and limited endoscopic access, a targeted enterotomy can enable intraoperative endoscopic hemostasis while preserving the existing reconstruction.
Why it matters
The report describes a potential rescue option when conventional endoscopic access is limited and embolization or formal surgical revision may carry important risks; further experience is needed to define its role.