Denny, Jason E

Kim, Dean

Malinzak, Lauren

Patel, Anita

Putchakayala, Krishna G

Takahashi, Kazuhiro

Denny, Jason

Henry Ford Health System Scholarly Commons

Henry Ford Health Henry Ford Health Scholarly Commons Surgery Articles Surgery 9-1-2016 Arterioenteric fistula 12 years after kidney transplant Kazuhiro Takahashi Henry Ford Health Anita Patel Henry Ford Health, Apatel2@hfhs.org Krishna G. Putchakayala Henry Ford Health Jason Denny Henry Ford Health, JDenny1@hfhs.org Dean Kim Henry Ford Health, DKIM3@hfhs.org See next page for additional authors Follow this and additional works at: https://scholarlycommons.henryford.com/surgery_articles Recommended Citation Takahashi K, Patel AK, Putchakayala KG, Denny JE, Kim DY, Malinzak LE. Arterioenteric fistula 12 years after kidney transplant. Kidney Int. 2016 Sep;90(3):710. This Article is brought to you for free and open access by the Surgery at Henry Ford Health Scholarly Commons. It has been accepted for inclusion in Surgery Articles by an authorized administrator of Henry Ford Health Scholarly Commons. Authors Kazuhiro Takahashi, Anita Patel, Krishna G. Putchakayala, Jason Denny, Dean Kim, and Lauren Malinzak This article is available at Henry Ford Health Scholarly Commons: https://scholarlycommons.henryford.com/surgery_articles/242 Arterioenteric fistula 12 years afterkidney transplantKazuhiro Takahashi1, Anita K. Patel2, Krishna G. Putchakayala1, Jason E. Denny1, Dean Y. Kim1 and Lauren E. Malinzak11Department of Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, Michigan, USA; and 2Department of Nephrology andInternal Medicine, Henry Ford Hospital, Detroit, Michigan, USACorrespondence: Lauren E. Malinzak, 2799 West Grand Boulevard, Detroit, Michigan 48202, USA. E-mail: lmalinz1@hfhs.orgKidney International (2016) 90, 710; http://dx.doi.org/10.1016/j.kint.2016.05.022 Copyright ª 2016, International Society of Nephrology. Published byElsevier Inc. All rights reserved.A 55-year-old woman presented to the emergencydepartment with bright red blood per the rectum. Shehad a past medical history of end-stage renal diseasedue to diabetes. Her third and most recent renal transplantwas placed intraperitoneally in the right lower quadrant 12years before admission. She returned to hemodialysisfor chronic graft rejection 11 months earlier. Physical exami-nation revealed right lower quadrant tenderness and freshred rectal bleeding, and her hemoglobin was 12.0 g/dl.An abdominal computed tomography scan with i.v.contrast showed extravasation of the contrast into the gastro-intestinal tract (Figure 1). She became transiently hypoten-sive, and her repeat hemoglobin dropped to 5.9 g/dl.Catheter angiogram showed an arterial feeder arising fromthe transplant renal artery with active contrast extravasationinto the bowel, consistent with arterioenteric fistula(Figure 2). Emergent embolization of the feeder vessel wasperformed. She remained hemodynamically stable after theprocedure.The differential diagnosis for lower gastrointestinalbleeding in transplant patients is broad: ulceration fromopportunistic infections (cytomegalovirus, mucormycosis,and tuberculosis), posttransplant lymphoproliferative disor-der, and others. Arterioenteric fistula formation is rare aftersolid organ transplant. Thirteen cases have been reportedafter pancreas transplant and 2 cases after kidney transplant.It is associated with high mortality rate because of massive,rapid hemorrhage and difficulty with diagnosis. It requires ahigh level of suspicion, as presentation may be nonspecificother than bleeding. This case increases awareness of a rarecause of massive hemorrhage that can lead to significantmortality after kidney transplant.Figure 1 | Abdominal computed tomography scan with i.v.contrast. Extravasation of contrast into the bowel (arrow). Txp kidney,transplant kidney.Figure 2 | Catheter angiogram. Extravasation of contrast from anarterial feeder arising directly from the transplant renal artery (TxpRA). Contrast extravasation to the bowel (arrows). IA, iliac artery.nephro logy image www.k idney - i n t e rna t i ona l . o rg710 Kidney International (2016) 90, 710

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Arterioenteric fistula 12 years after kidney transplant

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Arterioenteric fistula 12 years after kidney transplant

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