Intestinal Obstruction Due to Internal Hernia Following Pancreas Transplantation M.M. Linhares, L. del Grande, A. Gonzalez, F.P. Vicentine, A. Salzedas, E. Rangel, J.R. Sá, C. Melaragno, M.G. Souza, D. Matos, G.J. Lopes-Filho, and J.O. Medina Pestana ABSTRACT Background. Simultaneous pancreas-kidney transplantation has evolved as the best treatment for type 1 diabetic patients at end-stage renal disease. The surgical complication rate is high, which is an important barrier to the success of this procedure. The frequent complications that require relaparotomies include fistulas, graft thromboses, and intra- abdominal abscesses. Intestinal obstructions after pancreas transplantation due to internal herniation are not common. Purpose. The objective of this article was to review the literature about this problem and describe our personal experience in pancreas transplantation. Methods. We examined the cases of small bowel obstruction secondary to an internal hernia after following 292 pancreas transplantations in our center from 2000 to 2009 as well as performed a Medline literature review. Results. Only 2 articles described the diagnosis and treatment of internal hernias after pancreas transplantation. However, both contribution were from the same center report- ing the same 3 cases, with surgical versus radiologic perspectives. We have described our 2 cases of young pancreas-kidney transplant patients who presented with acute intestinal obstruction due to internal hernia. Conclusion. Although internal hernias are rare, they are potentially fatal and difficult to diagnose when they occur after pancreas transplantation. Detection with early surgery demands a high degree of clinical vigilance. S imultaneous pancreas-kidney transplantation (SPKT) is recognized by the American Diabetes Association as the best treatment for type 1 diabetes patients with end- stage renal disease. It is the only effective therapy to restore normal glucose metabolism, improving patient quality of life and reducing chronic complications of insulin-dependent diabetes. 1 Morbidity related to surgical complications continues to be a major problem after pancreas transplantation. 2 An important barrier to success is the high rate of surgical complications, which may require relaparotomies or graft removal. 3 The main causes of reoperation are generally anasto- motic fistulas, graft thromboses, and intra-abdominal ab- scesses. 4,5 Intestinal obstructions after pancreas transplan- tation are not common. Their etiology does not differ from that of major abdominal operations such as incisional hernias and adhesions. 4 Although there are no statistically significant differences among outcomes after bladder drain- age (BD) versus enteric drainage (ED), BD patients show a higher rate of surgical complications. 6 However, pancreas transplantation with ED creates an unusual condition for intestinal obstruction: internal hernias. The present article reports 2 cases of acute abdominal obstruction secondary to an internal hernia after pancreas transplantation and re- views the literature. METHODS Simultaneous pancreas-kidney transplantation is increasingly per- formed and shows better pancreatic graft survival. At our center, From the Universidade Federal de São Paulo - Unifesp - EPM, São Paulo, Brazil. Address reprint requests to Dr Marcelo Linhares, Av. Ibi- rapuera, 2907 - Cj. 218, São Paulo, CEP: 04029-200, Brazil. E-mail: marcelo@gastroenterologie.com.br 0041-1345/10/$–see front matter © 2010 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2010.06.021 360 Park Avenue South, New York, NY 10010-1710 3660 Transplantation Proceedings, 42, 3660 –3662 (2010)