tailieunhanh - báo cáo khoa học: "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"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: 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 | Hărle et al. Journal of Medical Case Reports 2010 4 357 http content 4 1 357 jAg JOURNALOF medical ÌỤr case REPORTS CASE REPORT Open Access 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 I I -Á r I 1Ce I -A T2 11 11 I -A I -A AA S S -A r AA A V3 11 I m AA c I rs I A AA A A I r I 3 r tr A 1-A -A 4 D AAAA I AA A4 Peter rarle Stephan Schwarz Julia Langgartner Jurgen schOlmerich Gerhard Rogler Abstract 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 .

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