Tc-99m-labeled red blood cell scanning localizes anastomotic hemorrhage between the distal ileum and duodenal stump of an enteric-drained pancreas transplant

Increasing numbers of pancreas transplants are performed with enteric exocrine drainage. Complications are more difficult to diagnose in enteric-drained pancreas transplants than in bladder-drained pancreas transplants. A 41-year-old woman underwent a simultaneous kidney-pancreas transplant. She received a whole-organ pancreas transplant with exocrine drainage from the duodenal stump into the distal ileum. One week after operation, accelerated renal rejection developed and was treated with plasmapheresis. In a coagulopathic state from plasma-pheresis, marked hematochezia developed 2 weeks after operation. The Tc-99m-labeled red blood cell scan clearly identified anastomotic hemorrhage between the duodenal stump of the pancreas transplant and the ileum.