Unusual Case of Massive Gastrointestinal Hemorrhage
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Richard Woerndle
A 49-year-old woman presented to the emergency department with bright red rectal bleeding, a hemoglobin level of 8.6 g/dL, and a hematocrit level of 27.8%. Because of complications of type 1 diabetes mellitus, the patient received a pancreaticoduodenal transplant with ileum drainage 8 years before presentation. This allograft failed 5 months before presentation, presumably owing to rejection. Bleeding necessitated nearly continuous high-volume fluid resuscitation. Results of angiography revealed perfusion of the pancreatic allograft (panel A, arrow) and extravasation of contrast material into the small bowel (panel B, arrow; imaged obtained a few seconds later). Interventional radiologic and vascular surgery services were not available. Despite heroic measures that included Fogarty catheter placement in the allograft arterial pedicle, the patient died of exsanguination. In a 14-hour period, she received 24 U of packed red blood cells, 22 U of fresh frozen plasma, other blood products, and crystalloids. The present case illustrates the potentially devastating complication of an arterioenteric fistula after an enteric-drained pancreaticoduodenal transplant, which has also been noted in other cases.1-4
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Financial Disclosures: None reported.
References
1 Lopez NM Jeon H Ranjan D Johnston TD . Atypical etiology of massive gastrointestinal bleeding: arterio-enteric fistula following enteric drained pancreas transplant. Am Surg. 2004;70(6):529-532.10.1177/000313480407000614Search in Google Scholar
2 Higgins PD Umar RK Parker JR DiMagno MJ . Massive lower gastrointestinal bleeding after rejection of pancreatic transplants. Nat Clin Pract Gastroenterol Hepatol. 2005;2(5):240-244.10.1038/ncpgasthep0175Search in Google Scholar PubMed
3 Gritsch HA Shapiro R Egidi F Randhawa PS Starzi TE Corry RJ . Spontaneous arterioenteric fistula after pancreas transplantation. Transplantation. 1997;63(6):903-904.10.1097/00007890-199703270-00018Search in Google Scholar PubMed PubMed Central
4 Semiz-Oysu A Cwikiel W . Endovascular management of acute enteric bleeding from pancreas transplant. Cardiovasc Intervent Radiol. 2007;30(2):313-316.10.1007/s00270-006-0058-zSearch in Google Scholar PubMed
© 2012 The American Osteopathic Association
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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Articles in the same Issue
- Corrections
- Corrections
- Letters
- Support Legislation to Address Shortage of Chemotherapy Drugs
- Road Map for Curricular Development and Professional Success: The Life Cycle of a Primary Care Physician
- Editorials
- Realigning the JAOA: We Are Listening and Changing
- Imaging Gently: A Call for Awareness
- Original Contribution
- Use of Computed Tomography in Diagnosing Appendicitis: Redundant, Expensive, Toxic, and Potentially Unnecessary
- Review
- Osteopathic Manipulative Medicine for Carpal Tunnel Syndrome
- Case Report
- Elevated Factor VIII: An Unfamiliar Risk Factor for Cerebral Venous Thrombosis
- Clinical Images
- Unusual Case of Massive Gastrointestinal Hemorrhage
- Book Reviews
- Charlotte Weaver: Pioneer in Cranial Osteopathy
- CME Quiz
- CME Quiz
