Nonoperative management of gastrointestinal bleeding after a
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A 48-year-old male with type I diabetes and hypertension complicated by end-stage renal disease requiring dialysis for 1 year underwent an SPK transplant. The pancreas transplant was performed using the entero-systemic drainage technique as a hand-sewn side-to-side anastomosis between the donor duodenum and the recipient mid-jejunum, ~150 cm away from the ligament of Tritez with two layers. The patient initially progressed well through his operative course as expected. He had adequate blood glucose control without exogenous insulin, and adequate urine output, and normal creatinine. Prior to discharge, he started to develop hematochezia that required blood transfusion.

The Department of Gastroenterology was consulted to performing an esophago-gastro-duodenoscopy to rule out upper GI bleeding, which noted a normal esophagus, stomach and duodenum. However, the endoscopic exam indicated bright red blood refluxing from the jejunum. A push enteroscopy technique was utilized by the gastroenterologist, who was able to visualize the duodenojejunostomy anastomosis and find the bleeding jejunum ulcer proximal to the anastomosis with an adherent clot near the site of anastomosis. The area was washed out and injected with 6 ml of 1:10 000 solution of epinephrine for hemostasis and two GI clips were placed. Post-procedure, his hemoglobin stabilized, and within 2 days, he was able to be discharged home.

Source:https://academic.oup.com/jscr/article/2020/10/rjaa433/5928450
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