Pancreatic allograft thrombosis

Case contributed by Maradona Marcos Gabriel

Presentation

A 40-year-old man with type I diabetes. Presents with abdominal pain and hyperglycemia 8 days after simultaneous transplantation of kidney and pancreas.

Patient Data

Age: 40 years
Gender: Male
ultrasound

IMAGE A: 

  •   US-image demonstrating VP and VE expanded, filled with echoes.
  •    Pancreas is heterogeneous, hypoechoic. Peripancreatic fluid collection.

IMAGE B:

  •  US-Duplex image within the pancreas parenchyma shows reversed end-diastolic flow in an intrapancreatic artery.
  • Venous waveforms could not be identified.

Central occlusive thrombosis of the PV. Normal pancreatic transplant enhancement. Post-contrast axial CT. Peripancreatic fluid collection.

Diagram

Illustration of the pancreas transplantation techniqueVCI: Inferior Vena Cava. VICD:  Right Common Iliac Vein. AO: Aorta. VP:  Portal Vein. VMS:  Superior Mesenteric Vein.  VE: Splenic Vein.  AICD:  Right Common Iliac Artery. IY: graft in ¨y¨ AMS: Superior Mesenteric Artery. AE: Splenic Artery.

Autore: G. Maradona

Case Discussion

Simultaneous transplantation of kidney and pancreas is a surgical option most used in patients with diabetic nephropathy. Complications can be classified into medical/surgical. 

Venous thrombosis is the most serious surgical complication and it is a cause of pancreatic loss. It is the second most important complication after rejection. and has a frequency of between 2-19% and typically presents a few weeks after transplant. 

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