Gastrointestinal Bleeding From Enteric Anastomosis in Simultaneous Pancreas/Kidney Transplantation: A Novel Hybrid Approach.

BACKGROUND: Simultaneous pancreas-kidney transplantation (SPK) with enteric drainage is the preferred treatment for selected patients with type 1 diabetes mellitus and end-stage renal disease. Despite its benefits, pancreas transplantation remains associated with the highest rate of surgical complications among solid organ transplants. Gastrointestinal bleeding originating from the donor-recipient enteric anastomosis is an uncommon but potentially life-threatening complication. Conventional management options include endoscopic therapy, interventional radiology embolization, and surgical revision; however, altered postoperative anatomy may limit endoscopic access, embolization carries a risk of bowel ischemia, and surgical revision may increase morbidity and jeopardize graft integrity. CASE PRESENTATION: We describe 2 patients who developed severe gastrointestinal bleeding from the donor-recipient enteric anastomosis following SPK. Both patients underwent exploratory laparotomy with creation of a targeted enterotomy, allowing direct intraoperative endoscopic access to the bleeding site. Hemostasis was successfully achieved using endoscopic clips while preserving the existing duodenojejunostomy. No recurrent bleeding, anastomotic complications, or graft-related adverse events occurred. At 8 and 4 years of follow-up, respectively, both pancreatic and renal grafts remained functional without transplant-related rehospitalizations. CONCLUSION: A hybrid surgical-endoscopic approach may represent a feasible rescue strategy for selected patients with persistent enteric anastomotic bleeding after SPK. This technique allows precise hemostatic control while preserving the enteric reconstruction and avoiding the potential morbidity associated with embolization or formal surgical revision. Further experience is needed to define its role relative to alternative treatment strategies.