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A case report of percutaneous direct injection of N-butyl-2-cyanoacrylate (NBCA) to treat a pancreatic duodenal stump leak after a simultaneous pancreas and kidney transplantation
| Title: | A case report of percutaneous direct injection of N-butyl-2-cyanoacrylate (NBCA) to treat a pancreatic duodenal stump leak after a simultaneous pancreas and kidney transplantation |
| Authors: | Shirakawa, Chisato Browse this author | | Watanabe, Masaaki Browse this author →KAKEN DB | | Shimamura, Tsuyoshi Browse this author | | Koshizuka, Yasuyuki Browse this author | | Kawamura, Norio Browse this author | | Goto, Ryoichi Browse this author | | Soyama, Takeshi Browse this author | | Iwami, Daiki Browse this author | | Hotta, Kiyohiko Browse this author | | Taketomi, Akinobu Browse this author | | Abo, Daisuke Browse this author |
| Keywords: | Simultaneous pancreas and kidney transplantation | | Duodenal stump leakage on pancreas graft | | Direct injection of N-butyl-2-cyanoacrylate (NBCA) |
| Issue Date: | 8-Jun-2021 |
| Publisher: | Springer |
| Journal Title: | Surgical case reports |
| Volume: | 7 |
| Issue: | 1 |
| Start Page: | 139 |
| Publisher DOI: | 10.1186/s40792-021-01219-2 |
| Abstract: | Background Simultaneous pancreas and kidney transplantation (SPK) is a treatment option for patients with end-stage renal disease due to type 1 diabetes mellitus. We report a patient with a refractory fistula due to leakage from the duodenal stump of the pancreas graft after an SPK with bladder drainage who was successfully treated with a percutaneous direct injection of N-butyl-2-cyanoacrylate (NBCA). Case presentation A 60-year-old female with a 33-year history of type 1 diabetes mellitus and a 10-year history of renal replacement therapy underwent an SPK in 2015. At the time of transplantation, an abdominal aortic aneurysm with a high risk of rupture was treated by a Y-graft replacement prior to the SPK. Bladder drainage of the pancreas graft was chosen to avoid a vessel graft infection. The patient's postoperative course was uneventful. The patient was discharged on postoperative day 93 with good-functioning pancreas and kidney grafts. One and a half years after the operation, the patient was found to have acute graft pancreatitis and a leak from the duodenal stump of the pancreas graft due to a paralytic neurogenic bladder. The insertion of an indwelling catheter into the bladder and the endoscopic-guided insertion of a catheter into the graft pancreatic duct through the duodenum/bladder anastomosis did not result in the closure of the fistula. Therefore, NBCA was injected at the site of the leak point using CT-guided technique. The fistula was completely closed immediately after the injection, with no recurrences of leaks. Conclusions A percutaneous direct injection of NBCA is one of the treatment options to treat intractable fistulas. |
| Type: | article |
| URI: | http://hdl.handle.net/2115/82367 |
| Appears in Collections: | 医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
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