Tc-99m–Labeled Red Blood Cell Scanning Localizes Anastomotic Hemorrhage Between the Distal Ileum and Duodenal Stump of an Enteric-Drained Pancreas Transplant

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Increasing numbers of pancreas transplants are performed with enteric exocrine drainage. Complications are more difficult to diagnose in enteric-drained pancreas transplants than in bladder-drained pancreas transplants. A 41-year-old woman underwent a simultaneous kidney–pancreas transplant. She received a whole-organ pancreas transplant with exocrine drainage from the duodenal stump into the distal ileum. One week after operation, accelerated renal rejection developed and was treated with plasmapheresis. In a coagulopathic state from plasmapheresis, marked hematochezia developed 2 weeks after operation. The Tc-99m–labeled red blood cell scan clearly identified anastomotic hemorrhage between the duodenal stump of the pancreas transplant and the ileum.
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