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
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.
Illustration of the pancreas transplantation technique: VCI: 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.