A case of graft duodenal bleeding after brain-dead pancreas transplantation successfully treated with interventional radiology resulting in the graft preservation

Abstract

Graft duodenal bleeding is one of the complications after pancreas transplantation that may lead to graft loss. To date, few reports have described graft preservation with conservative treatment for graft duodenal bleeding. Herein, we described a case in which graft preservation was achieved after graft duodenal bleeding from graft gastroduodenal artery (GDA) treated with interventional radiology (IVR). The patient was a 48-year-old man who had undergone brain-dead pancreas-kidney transplantation for type 1 diabetes and renal failure at the age of 42 years. Three months ago, he visited a local physician for bloody stools. An upper and lower gastrointestinal endoscopy did not reveal a source of bleeding, and his symptoms spontaneously resolved. One month later, he again experienced bloody stools. Abdominal contrast-enhanced CT revealed a hematoma in the graft duodenum, leading to emergency hospitalization. Double-balloon endoscopy via the anus was performed, but the bleeding source was not identified, and his symptoms resolved spontaneously again, leading to discharge. Three weeks after the discharge, he presented with bloody stools and abdominal pain and was transferred to our hospital for further evaluation and treatment. At that time, his pancreas and kidney grafts functioned well. He was diagnosed graft duodenal bleeding by abdominal CT. We performed angiography via the graft celiac artery and identified bleeding from a branch of the graft GDA, anterior superior pancreaticoduodenal artery (ASPDA). Although a possibility was considered that embolization of this branch might cause ischemia of the graft duodenum, we planned to treat the bleeding with embolization by IVR because the branch was relatively peripheral, we performed coil embolization by IVR and achieved hemostasis of the graft GDA. At 1 year and 3 months after the treatment, the patient remained alive without graft duodenal rebleeding and his pancreas graft functions were maintained. This case suggested that embolization by IVR may be an effective treatment for such bleeding from the graft.