SBO, pancreatic and renal transplants

Case contributed by Assoc Prof Craig Hacking

Presentation

Epigastric pain and vomiting.

Patient Data

Age: 65 years
Gender: Male

The native kidneys and pancreas are severely atrophic. The renal transplant in the left iliac fossa demonstrates normal perfusion and there is no obstruction or focal lesion evident. No perinephric fat stranding. The pancreatic transplant is located in the right iliac fossa. The adjacent portion of the donor duodenum appears blind-ending and is dilated and contains fecalised material. The small bowel upstream from this is dilated and fluid-filled within the upper abdomen. The distal small bowel and large bowel is not dilated. There is no fat stranding surrounding the pancreas transplant. The vascular anastomosis to the iliac vessels is normal.

No retroperitoneal or free intraperitoneal fluid. The spleen, adrenal glands and liver are unremarkable. The gallbladder is contracted and contains numerous calculi. No biliary dilatation. Extensive native vascular calcification.

Left lower lobe ovoid lesion with calcification is stable. Minor posterior atelectasis at the lung bases. Extensive coronary artery and mitral annular calcification.

No focal or diffuse bony abnormality.

IMPRESSION

Dilated donor duodenum adjacent to the pancreatic transplant, with fecalised luminal contents indicating the transition point for upstream small bowel obstruction.

Case Discussion

The patient had a history of multiple low-grade SBOs and was successfully managed conservatively.

The transplants were performed over a decade earlier for diabetes.

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Case information

rID: 78271
Published: 14th Jul 2020
Last edited: 14th Jul 2020
Inclusion in quiz mode: Included