Pancreatic
transplantation is currently the only effective cure for
Type 1 diabetes mellitus. It allows long-term
glycemic control without exogenous
insulin and amelioration of secondary
diabetic complications. In India, pancreas transplant has not yet established with only a single successful transplant reported so far in the literature. We report a 24-year-old Type 1 diabetic patient with
renal failure who underwent a simultaneous pancreas kidney transplant. On postoperative day 15, he had leak from the graft duodenal stump for which a tube
duodenostomy and proximal diversion
enterostomy was done. He had a high output
pancreatic fistula following the procedure which was managed conservatively. The tube
duodenostomy was removed at three and half months and
enterostomy closure with restoration of bowel continuity was done at 6 months. After a follow up of 7 months, patient is doing well with a serum
creatinine of 0.8 mg/dl and normal blood
sugars, not requiring any exogenous
insulin or oral
hypoglycemic drugs. Managing patients with graft duodenal complications after pancreas transplant is challenging. Tube
duodenostomy is a safe option in management of duodenal leak, although can lead to a persistent
pancreatic fistula. A proximal diversion
enterostomy allows early oral feeding and avoids the cost as well as the long term complications associated with
parenteral nutrition.