Abstract | April 4, 2022

Ectopic intestinal varices following pancreatic transplant: A case series

Presenting Author: Jacob Kosyakovsky, B.S, Medical Student, 3rd Year, School of Medicine, University ofmVirginia, Charlottesville, VA

Coauthors: Kosyakovsky Jacob, B.S, School of Medicine, University of Virginia, Charlottesville, VA, USA; Robinson Todd J, MD, Division of Transplant Surgery, Department of Surgery, Charles O. Strickler Transplant Center, University of Virginia Health System, Charlottesville, VA, USA; Rao Swati, MD, Division of Nephrology, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA; Taylor Amy C, MD, Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA; Brayman Kenneth L, MD, Division of Transplant Surgery, Department of Surgery, Charles O. Strickler Transplant Center, University of Virginia Health System, Charlottesville, VA, USA; Agarwal Avinash K, MD, Division of Transplant Surgery, Department of Surgery, Charles O. Strickler Transplant Center, University of Virginia Health System, Charlottesville, VA, USA

Learning Objectives

  1. Describe common vascular complications following pancreatic transplant;
  2. Discuss the etiology and clinical manifestations of ectopic intestinal varices;
  3. Identify key steps in the diagnosis and management of ectopic intestinal varices.

Background/Knowledge Gap: Ectopic variceal bleeding is a potentially underrecognized source of gastrointestinal (GI) hemorrhage. While vascular complication following pancreatic transplant is relatively common, the development of symptomatic ectopic venous varices has rarely been reported.

Methods/Design: We describe a case series of two patients with a remote history of pancreas transplant presenting with occult GI bleed. Both patients presented decades after transplant with intermittent melena and anemia requiring multiple transfusions.

Results/Findings: In both cases, a lengthy diagnostic course was unrevealing until incidental discovery of non-cirrhotic ectopic varices around the transplanted bowel on MR or CT enterography. These varices were successfully treated with coil embolization via a transhepatic approach with preserved graft outcomes.

Conclusions/Implications: Our findings add to the scant literature on this topic and should aid in the recognition, diagnosis, and management of this unusual presentation.

Posted in: Surgery & Surgical Specialties35