Coloduodenovesical Fistula After Simultaneous Pancreas-Kidney Transplant: Case Report and Review of the Literature

Transplant Proc. 2017 Oct;49(8):1960-1962. doi: 10.1016/j.transproceed.2017.04.009.

Abstract

Background: Complicated diverticulitis after transplantation occurs in as many as 3.5% of cases and carries a 25% mortality rate. Diagnosis of complicated diverticulitis in this population can be challenging because of abnormal presentations caused by immunosuppression. Only 4 cases of fistulization after kidney transplantation are described in the literature; none occurred after simultaneous pancreas-kidney transplant.

Methods: We present a first case of a coloduodenovesical fistula in a patient 9 years after simultaneous pancreas-kidney transplant. The patient presented with intermittent episodes of elevated creatinine and recurrent urinary tract infection. The presence of fistula was strongly suspected in cystoscopy, but, despite extensive investigation, a fistula tract could not be identified.

Results: The patient ultimately underwent surgical exploration for positive cystoscopy examination, continuation of urinary complaints, and presence of multiple colonic diverticula in computed tomography scan. At surgical exploration, a fistula track was identified between the sigmoid colon and duodenal stump of the pancreas allograft. Subsequently, sigmoidectomy, bladder repair, and enteric conversion of the pancreas transplant were performed.

Conclusions: Complications of diverticulitis should be considered in organ transplant recipients presenting with recurrent urinary infection and elevated creatinine, and surgical exploration might be indicated even if unable to well-define the fistula tract.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Colon, Sigmoid
  • Diverticulitis / diagnosis
  • Diverticulitis / etiology*
  • Duodenum
  • Humans
  • Intestinal Fistula / diagnostic imaging
  • Intestinal Fistula / etiology*
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Pancreas Transplantation / adverse effects*
  • Postoperative Complications
  • Sigmoid Diseases / etiology*
  • Urinary Bladder Fistula / diagnostic imaging
  • Urinary Bladder Fistula / etiology*
  • Urinary Tract Infections / etiology