Reflux into redundant duodenal stump of pancreatic allograft imitates duodenal stump leak on Tc-99m MAG3 imaging

Tc-99m MAG3 scintigraphy is useful in the diagnosis of renal-pancreatic allograft dysfunction. A 35-year-old man who had a cadaveric kidney-pancreas transplant 6 weeks earlier was admitted for acute allograft rejection. A pelvic sonogram showed a large peripancreatic fluid collection. A Tc-99m MAG3 scan showed reflux in to the large, redundant duodenal stump of pancreatic allograft, which was initially mistaken to be a leak from the duodenal stump. The peripancreatic fluid collection was later identified to be a lymphocele (not a urinoma or duodenal stump leak). The authors present this case to emphasize that knowledge of the transplant anatomy, as well as clinical symptomatology, is essential before the diagnosis of a duodenal stump leak can be made.