The enteric drained pancreas transplant: another potential source of gastrointestinal bleeding

With most combined kidney and pancreas transplants the transplant pancreatic exocrine secretions are managed with urinary bladder drainage. Because of the associated metabolic and infectious complications, many pancreatic transplants require later conversion to enteric drainage, and the trend in this country is now toward primary enteric drainage. Unlike with urinary bladder drainage when direct cystoscopy can be performed, a disadvantage with enteric drainage is that problems such as bleeding from a transplanted pancreas and attached duodenal segment are not easily evaluated. A case of a cytomegalovirus-related bleeding ulcer in an enteric drained pancreas is presented, along with a review of the possible diagnostic evaluation.