DOI: 10.1097/TP.0b013e31820cfd91
,
,
PMID: 21436649
Issn Print: 0041-1337
Publication Date: 2011/04/15
Facebook
Twitter
LinkedIn
Email
 |
Checking for direct PDF access through Ovid | |
Excerpt
During next 24 hr, the patient remained in the intensive care unit; during this time, he maintained normal blood glucose levels off insulin, a good urine output, and achieved a decrease in his creatinine from a baseline of 392 to 340 μmol/L. There was an unexplained nonanion gradient metabolic acidosis and hyperkalemia on a blood gas with a pH of 7.22, PCO2 6.07 kPa, PO2 17.5 kPa, lactate 1.7 mmol/L, K 6.1 mmol/L, and a base deficit of −8.1 mEq/L. An ultrasound scan of the kidney demonstrated no hydronephrosis and adequate perfusion. A subsequent magnetic resonance angiography (MRA) of the transplanted pancreas was performed and suggested SMA thrombosis of the graft.
The patient was taken to theater for exploration. On laparotomy, the donor duodenum was noted to be dusky in appearance with a pale appearing pancreatic head and pulse-less SMA occluded by the mesenteric staple line. In the absence of an available tissue bank and heavily calcified native vessels, the thrombosed segment of the donor SMA was dissected out in its intrapancreatic course until the staple line on the mesenteric end. A branch of the Y graft was subsequently removed to facilitate elongation of the arterial graft (Fig. 1). This conduit was used to create an inflow into the gastroduodenal artery (GDA). The duodenum and head of pancreas were noted to become pink after reperfusion of GDA.
Postoperatively the metabolic acidosis and hyperkalemia improved. He continued to achieve normal blood glucose levels off insulin, and his creatinine level decreased to 124 μmol/L. A postoperative MRA demonstrated good flow to both the splenic and GDA. The recipient was discharged 15 days postoperatively and continues to remain well.
