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首页> 外文期刊>Journal of Medical Case Reports >Volcano-like intermittent bleeding activity for seven years from an arterio-enteric fistula on a kidney graft site after pancreas-kidney transplantation: a case report
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Volcano-like intermittent bleeding activity for seven years from an arterio-enteric fistula on a kidney graft site after pancreas-kidney transplantation: a case report

机译：胰腺-肾脏移植后肾移植部位动-肠瘘的类火山间歇性出血活动长达七年：一例

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Introduction We report the first case of a patient who underwent simultaneous kidney and pancreas transplantation and who then suffered from repeated episodes of severe gastrointestinal bleeding over a period of seven years. Locating the site of gastrointestinal bleeding is a challenging task. This case illustrates that detection of an arterio-enteric fistula can be very difficult, especially in technically-challenging situations such as cases of severe intra-abdominal adhesions. It is important to consider the possibility of arterio-enteric fistulas in cases of intermittent bleeding episodes, especially in transplant patients. Case presentation A 40-year-old Caucasian man received a combined pancreas-kidney transplantation as a result of complications from diabetes mellitus type I. Thereafter, he suffered from intermittent clinically-relevant episodes of gastrointestinal bleeding. Repeat endoscopic, surgical, scintigraphic, and angiographic investigations during his episodes of acute bleeding could not locate the bleeding site. He finally died in hemorrhagic shock due to arterio-enteric bleeding at the kidney graft site, which was diagnosed post-mortem. Conclusions In accordance with the literature, we suggest considering the removal of any rejected transplant organs in situations where arterio-enteric fistulas seem likely but cannot be excluded by repeat conventional or computed tomography-angiographic methods. Arterio-enteric fistulas may intermittently bleed over many years.
机译：引言我们报告了第一例同时进行肾脏和胰腺移植的患者，然后在七年时间内反复发作严重的胃肠道出血。找到胃肠道出血的位置是一项艰巨的任务。这种情况说明，检出动肠瘘可能非常困难，尤其是在技术上具有挑战性的情况下，例如严重的腹腔内粘连的情况。在间歇性出血事件中，尤其是移植患者中，考虑动肠瘘的可能性很重要。病例介绍由于I型糖尿病的并发症，一名40岁的白人男子接受了胰肾联合移植手术。此后，他患有间歇性临床相关的胃肠道出血。在他的急性出血发作期间，重复进行内窥镜检查，外科手术，闪烁显像和血管造影检查无法找到出血部位。他最终因在肾移植部位的动肠出血而死于失血性休克，死后被诊断为死亡。结论根据文献，我们建议考虑在可能出现动肠瘘但不能通过传统的或计算机断层摄影-血管造影方法排除的情况下，去除任何排斥的移植器官。多年来，动肠瘘可能会间歇性出血。

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