Management of small bowel volvulus in a patient with simultaneous pancreas-kidney transplantation (SPKT): a case report

Abstract

There are several surgical complications which can occur following simultaneous pancreas-kidney transplantation (SPKT). Although intestinal obstruction is known to be a common complication after any type of abdominal surgery, the occurrence of small bowel volvulus, which is one of the rare causes of intestinal obstruction, following SPKT has not been published before. A 24-year-old woman suffering from type I diabetes mellitus with complications of nephropathy resulting in end stage renal disease (ESRD), neuropathy and retinopathy underwent SPKT. On the postoperative month 5, she was brought to the emergency service due to abdominal distention with mild abdominal pain. After laboratory research and diagnostic radiological tests had been carried out, she underwent exploratory laparotomy to determine the pathology for acute abdominal symptoms. Intra-operative observation revealed the presence of an almost totally ischemic small bowel which had occurred due to clockwise rotation of the mesentery. Initially, simple derotation was performed to avoid intestinal resection because of her risky condition, particularly for short bowel syndrome, and subsequent intestinal response was favorable. Thus, surgical treatment was successfully employed to solve the problem without any resection procedure. The patient's postoperative follow-up was uneventful and she was discharged from hospital on postoperative day 7. According to our clinical viewpoint, this study emphasizes that if there is even just a suspicion of acute abdominal problem in a patient with SPKT, surgical intervention should be promptly performed to avoid any irreversible result and to achieve a positive outcome.

Figure 1

a: The diaphragmatic representation of the SPKT performed in this case. Enteric drainage for pancreatic graft was carried out. 1b: Diaphragmatic representation of the anatomy found at re-operation. Initiation of the ischemic intestinal segment was from the beginning of the enteroenterostomy (brown arrows with double endings), white arrows indicated the healthy intestine between the red square brackets 30 cm distal to the Treitz ligament. The point of the torsion of the mesentery was shown in red square. 1c: Ischemic small intestinal segment secondary to volvulus. 1d: Torsion of mesentery of the small intestine

Figure 2

View of the small intestine with a good blood supply, after derotation procedure.