Pancreatitis as complication of pancreas transplantation

46 years old woman with a 24 hours-evolution abdominal pain and vomits. Pancreas and kidney transplant in 2014. Plain abdominal radiography shows air/water levels (image A). Intestinal obstruction was suspected and an urgent Computer Tomograhpy (CT) was required to us. CT showed dilation of the small bowel with transitional zone in ileocaecal junction (imagen C). Pancreatic graft was located in the right flank with parenchymal edema, fluid surrounding and inflammatory signs of the mesenteric fatty (1) (image B). The native pancreas was normal (image D).

Two different radiographic findings could explain the abdominal pain of the patient: 1. Intestinal obstruction with an ileocaecal transition zone, probably due to adhesions (image C). 2. Findings suggestive of pancreatitis of the pancreatic graft. These findings are more important in the head of the transpant, with parenchymal edema and free fluid surrounding (Image B). An urgent exploratory laparotomy was carried out. Many adhesions which could cause the obstructive problem were observed and removed. The patient evolved favourably, disappearing the obstructive problem and lowering the amylase levels.

An obstructive problem for adhesions should be suspected when a CT with no apparent cause appear in patients with surgical record. The pancreatitis of the pancreas graft is an unusual complication, being responsible, sometimes, the cause of a graft rejection (2).

- Tolat PP, Foley WD, Johnson C, Hohenwalter MD, Quiroz FA. Pancreas Transplant Imaging: How I Do It. Radiology. 2015, 275:14-27. - Redfield RR, Kaufman DB, Odorico JS. Diagnosis and Treatment of Pancreas Rejection. Curr Transpl Rep. 2015, 2:169–175.