Iliac artery-enteric fistulas following failed pancreatic transplant
Arterial-enteric fistulas occur from a multitude of causes, especially following surgical manipulation of vasculature. The development of an iliac artery-enteric fistula (IEF) occurs rarely in patients with failed pancreatic transplants. IEFs warrant urgent intervention due to the high mortality fro...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-04-01
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| Series: | Journal of Vascular Surgery Cases and Innovative Techniques |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S246842872400011X |
| _version_ | 1797248285482680320 |
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| author | Lorela B. Weise, MD Paul R. Crisostomo, MD Carlos F. Bechara, MD Michael C. Soult, MD |
| author_facet | Lorela B. Weise, MD Paul R. Crisostomo, MD Carlos F. Bechara, MD Michael C. Soult, MD |
| author_sort | Lorela B. Weise, MD |
| collection | DOAJ |
| description | Arterial-enteric fistulas occur from a multitude of causes, especially following surgical manipulation of vasculature. The development of an iliac artery-enteric fistula (IEF) occurs rarely in patients with failed pancreatic transplants. IEFs warrant urgent intervention due to the high mortality from hemorrhagic and septic shock. The diagnosis can be delayed by a lack of suspicion, the low sensitivity of diagnostic tests, and the nonspecific signs of fistulas on computed tomography. The management of IEFs is adapted from guidelines for arterial-enteric fistulas of other causes, with little consensus on ideal vascular reconstruction and postoperative antimicrobial management. The outcomes are limited to the short-term results from case reports and case series. We report two cases of IEFs in patients with a history of simultaneous pancreatic kidney transplant. Our patients underwent successful resolution of gastrointestinal bleeding and sepsis, with definitive management of fistula resection and interposition iliac artery bypass. The index of suspicion for IEFs should be high, and they should be considered as a source of anemia or gastrointestinal bleeding of an unknown source in patients with failed pancreatic transplant. Definitive management should be pursued in patients who can tolerate fistula resection, allograft explant, and arterial reconstruction. |
| first_indexed | 2024-03-08T02:00:57Z |
| format | Article |
| id | doaj.art-8a03b0addbd946879a5cc57964e8fc59 |
| institution | Directory Open Access Journal |
| issn | 2468-4287 |
| language | English |
| last_indexed | 2024-04-24T20:12:10Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Vascular Surgery Cases and Innovative Techniques |
| spelling | doaj.art-8a03b0addbd946879a5cc57964e8fc592024-03-23T06:25:37ZengElsevierJournal of Vascular Surgery Cases and Innovative Techniques2468-42872024-04-01102101427Iliac artery-enteric fistulas following failed pancreatic transplantLorela B. Weise, MD0Paul R. Crisostomo, MD1Carlos F. Bechara, MD2Michael C. Soult, MD3Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University of Chicago, Maywood, ILDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University of Chicago, Maywood, ILDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University of Chicago, Maywood, ILCorrespondence: Michael C. Soult, MD, Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University of Chicago, Maywood, ILArterial-enteric fistulas occur from a multitude of causes, especially following surgical manipulation of vasculature. The development of an iliac artery-enteric fistula (IEF) occurs rarely in patients with failed pancreatic transplants. IEFs warrant urgent intervention due to the high mortality from hemorrhagic and septic shock. The diagnosis can be delayed by a lack of suspicion, the low sensitivity of diagnostic tests, and the nonspecific signs of fistulas on computed tomography. The management of IEFs is adapted from guidelines for arterial-enteric fistulas of other causes, with little consensus on ideal vascular reconstruction and postoperative antimicrobial management. The outcomes are limited to the short-term results from case reports and case series. We report two cases of IEFs in patients with a history of simultaneous pancreatic kidney transplant. Our patients underwent successful resolution of gastrointestinal bleeding and sepsis, with definitive management of fistula resection and interposition iliac artery bypass. The index of suspicion for IEFs should be high, and they should be considered as a source of anemia or gastrointestinal bleeding of an unknown source in patients with failed pancreatic transplant. Definitive management should be pursued in patients who can tolerate fistula resection, allograft explant, and arterial reconstruction.http://www.sciencedirect.com/science/article/pii/S246842872400011XArterio-enteric fistulaIliac artery to small bowel fistulaGI bleed in failed pancreatic transplant |
| spellingShingle | Lorela B. Weise, MD Paul R. Crisostomo, MD Carlos F. Bechara, MD Michael C. Soult, MD Iliac artery-enteric fistulas following failed pancreatic transplant Journal of Vascular Surgery Cases and Innovative Techniques Arterio-enteric fistula Iliac artery to small bowel fistula GI bleed in failed pancreatic transplant |
| title | Iliac artery-enteric fistulas following failed pancreatic transplant |
| title_full | Iliac artery-enteric fistulas following failed pancreatic transplant |
| title_fullStr | Iliac artery-enteric fistulas following failed pancreatic transplant |
| title_full_unstemmed | Iliac artery-enteric fistulas following failed pancreatic transplant |
| title_short | Iliac artery-enteric fistulas following failed pancreatic transplant |
| title_sort | iliac artery enteric fistulas following failed pancreatic transplant |
| topic | Arterio-enteric fistula Iliac artery to small bowel fistula GI bleed in failed pancreatic transplant |
| url | http://www.sciencedirect.com/science/article/pii/S246842872400011X |
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