RESUMEN
The annular pancreas in adults is a rare congenital anomaly that is detected after development of complications, such as gastric outlet obstruction, recurrent pancreatitis, and peptic ulcer. Duodenal bypass is the procedure of choice for treating duodenal obstruction caused by the annular pancreas in both children and adults. Duodenoduodenostomy is routinely performed in neonates and children. In adults, duodenojejunostomy or gastrojejunostomy are recommended, because the duodenum is less mobile. We report a case of annular pancreas in a 33-year-old male that was successfully treated with laparoscopic gastrojejunostomy.
Asunto(s)
Adulto , Niño , Humanos , Recién Nacido , Masculino , Obstrucción Duodenal , Duodeno , Derivación Gástrica , Obstrucción de la Salida Gástrica , Laparoscopía , Páncreas , Enfermedades Pancreáticas , Pancreatitis , Úlcera PépticaRESUMEN
The calcineurin inhibitor-immunosuppressant tacrolimus is widely used in patients undergoing kidney transplantation. Although tacrolimus is absorbed from the entire gastrointestinal tract, the duodenum is the primary site of its absorption and metabolism. Therefore, duodenal bypass surgery in a renal transplant recipient can significantly disrupt tacrolimus absorption and metabolism. Here, we report a case of allograft failure that developed after duodenal bypass surgery. The patient was a 41-year-old woman who received a deceased donor kidney transplantation. She underwent a gastrojejunostomy due to a duodenal perforation and pancreatitis after endoscopic retrograde cholangiopancreatography. After the surgery, her blood tacrolimus level decreased gradually, and remained lower than therapeutic target levels, even after the tacrolimus dose was increased from 5 to 12 mg/day. Repetitive rejection developed and the patient suffered allograft failure 3 months after bypass surgery. This case raises the importance of drug absorption in renal transplant recipients undergoing duodenal bypass surgery.