ABSTRACT
Peripancreatic fluid collections are among the common post pancreas transplant complications, which are mainly due to leakage from the anastomosis site to bowel and graft pancreatitis. Differentiation between these two entities is important because they are treated differently. In this case, secretin stimulated magnetic resonance cholangiopancreatography revealed gradual intraperitoneal fluid collection and accumulation of fluid in small bowel excluded leakage from the anastomosis of the pancreas to bowel and changed the management from surgery to medical treatment.
Subject(s)
Abscess/diagnosis , Abscess/etiology , Pancreas Transplantation/adverse effects , Pancreas Transplantation/pathology , Pancreatic Fistula/diagnosis , Pancreatic Fistula/etiology , Pancreatitis, Graft/diagnosis , Pancreatitis, Graft/etiology , Acute Disease , Cholangiopancreatography, Magnetic Resonance/methods , Contrast Media , Female , Humans , Image Enhancement/methods , Middle Aged , SecretinABSTRACT
BACKGROUND: The majority of patients with end-stage renal disease are dependent on hemodialysis. Significant stenosis or occlusion of the subclavian vein is known to occur in 20% to 50% of patients who have had central venous catheters inserted into the subclavian vein or the internal jugular vein. Surgical bypass of the obstructed venous segment proximal to a functioning dialysis access site is an established treatment to relieve symptoms and salvage the functional dialysis access. STUDY DESIGN: A retrospective review of all subclavian venous bypass procedures performed at St Louis University Hospital from May 1987 to May 2000 was undertaken. Twelve procedures were performed during this time. The mean age of the patient was 55.5 years (range 17 to 72 years). There were 11 men and 1 woman. Before surgical bypass, all patients underwent bilateral venograms to evaluate their central venous systems. RESULTS: An extraanatomic surgical bypass was performed in all patients. Patients were followed for a mean of 16 months (range 1 to 79 months). At 1 month, 100% of hemodialysis access sites remained functional. At 1 year, 80%; 2 years, 60%; and 3 years, 25% of the salvaged arteriovenous hemodialysis access sites provided for functional dialysis. One patient required thrombectomy of the bypass graft at 14 months. CONCLUSIONS: Surgical bypass of an occluded or stenotic subclavian vein segment is successful in providing both symptomatic relief and salvage of a functioning dialysis access in the hemodialysis patient population. Study of the central venous system is essential in selecting an appropriate bypass procedure in individual patients.
Subject(s)
Arteriovenous Shunt, Surgical , Catheterization, Central Venous/adverse effects , Renal Dialysis , Subclavian Vein , Blood Vessel Prosthesis Implantation , Constriction, Pathologic/surgery , Female , Humans , Kidney Failure, Chronic/therapy , Male , Middle Aged , Polytetrafluoroethylene , Retrospective StudiesABSTRACT
En paciente con transplante renal son frecuentemente necesarias las intervenciones quirúrgicas electivas y de emergencia, por lo que es oportuno determinar la incidencia y el resultado quirúrgico en este tipo de operaciones. Se realizó un análisis retrospectivo de 273 transplantes renales consecutivos, entre enero de 1978 y noviembre de 1985. Durante este período, a 139 pacientes se les realizaron 162 procedimientos quirúrgicos diferentes. En 44 pacientes se hicieron 55 cirugías de emergencia o semiurgencias, 8 pacientes (18%) murieron en el postoperatório. Todas las muertes ocurrieron en pacientes llevados a operaciones mayores, abdominales y/o torácicas por víscera perforada, sangrado gastrointestinal, empiema y abscesos pulmonares; las causas de muerte fueron por sepsis e insuficiencia de múltiples órganos. En los sobrevivientes de procedimientos de emergencia, los niveles medios de creatinina sérica previos a la operación y posterior a las mismas fueron 2.87 mg% y 2.82 respectivamente. En 95 pacientes se realizaron 107 procedimientos quirúrgicos electivos, la mayoría de los cuales se hicieron bajo anestesia general, la mortalidad operatoria fue de 4.2%. En pacientes con transplante renal funcional al momento de la operación, los niveles séricos de creatinina antes y después de la cirugía fueron 1.74 y 1.64 mg% respectivamente. En conclusión procedimientos quirúrgicos intrabdominales y torácicos de emergencia en pacientes con transplante renal se asocian con alta mortalidad, en cambio los procedimientos selectivos tienen una mortalidad aceptable y no alteran el nivel funcional del transplante. De suma importancia, en estos pacientes, es el monitoreo del régimen de inmunosupresión, y la deteccicón temprana de complicaciones sépticas
