Pancreaticoduodenal transplantation with enteric drainage following native total pancreatectomy for chronic pancreatitis: A case report

Rainer W G Gruessner, C. Manivel, D. L. Dunn, D. E R Sutherland

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Pancreas transplantation is usually performed in patients with de novo type I diabetes, who have advanced secondary complications. We report a case in which whole pancreaticoduodenal transplantation, with enteric drainage, was performed to correct both endocrine and exocrine deficiencies in a patient with hyperlabile diabetes and steatorrhea, unresponsive to oral enzyme replacement therapy, following staged total pancreatectomy for idiopathic or familial chronic pancreatitis. The transplant was performed one year after completion of native pancreatectomy and immediately established an insulin-independent euglycemic state, with normal oral and intravenous glucose tolerance test results and correction of steatorrhea. Beginning one year posttransplant, the patient had intermittent episodes of steatorrhea, associated with mild elevation of blood sugar levels, which were presumed to be due to rejection and, indeed, responded to antirejection treatment with antilymphocyte globulin and temporary increases in steroids dosages. At 20 months posttransplant, steatorrhea did not respond to antirejection treatment and an acute abdomen developed. Laparotomy revealed a perforated graft duodenum, which was resected; pathology showed transmural necrosis secondary to chronic rejection. The pancreas graft itself was left in situ, disconnected from the intestinal tract. The patient remained normoglycemic after graft duodenectomy but resumed oral enzyme replacement therapy in an attempt to combat recurrence of severe steatorrhea. However, his overall situation remained improved compared to pretransplant, since the exocrine deficiency was tolerable in the absence of a diabetic state. Ten months postgraft duodenectomy (38 months posttransplant), elevations in blood sugar levels were treated with another course of antirejection treatment and levels temporarily declined. At 14 months postgraft duodenectomy (42 months posttransplant), graft endocrine function again declined and exogenous insulin was resumed. Six months later, four years after the original transplant, a new enteric-drained pancreaticoduodenal graft was placed, once again resulting in an insulin-independent, steatorrhea-free state. With improvements in immunosuppression, pancreas transplantation could be offered to selected patients with hyperlabile diabetes, following total pancreatectomy for benign disease; if the enteric drainage technique is used, in the absence of rejection, exocrine deficiency could be corrected as well.

Original languageEnglish (US)
Pages (from-to)479-488
Number of pages10
JournalPancreas
Volume6
Issue number4
StatePublished - 1991
Externally publishedYes

Fingerprint

Pancreatectomy
Steatorrhea
Chronic Pancreatitis
Drainage
Transplantation
Transplants
Enzyme Replacement Therapy
Pancreas Transplantation
Insulin
Glucose Tolerance Test
Blood Glucose
Acute Abdomen
Antilymphocyte Serum
Type 1 Diabetes Mellitus
Duodenum
Laparotomy
Immunosuppression
Pancreas
Necrosis
Therapeutics

Keywords

  • Diabetes
  • Exocrine deficiency
  • Pancreas
  • Pancreatitis
  • Transplantation

ASJC Scopus subject areas

  • Endocrinology
  • Gastroenterology

Cite this

Pancreaticoduodenal transplantation with enteric drainage following native total pancreatectomy for chronic pancreatitis : A case report. / Gruessner, Rainer W G; Manivel, C.; Dunn, D. L.; Sutherland, D. E R.

In: Pancreas, Vol. 6, No. 4, 1991, p. 479-488.

Research output: Contribution to journalArticle

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