Massive lower gastrointestinal bleeding after rejection of pancreatic transplants

Background: This article highlights two cases of massive lower gastrointestinal bleeding in patients on dialysis after rejection of kidney-pancreas transplants. Patient 1 was a 34-year-old female with 27 years of type I diabetes, who had a kidney-pancreas transplant in 1996, which was complicated by rejection of the kidney and pancreas in 2000 and 2002, respectively. Later in 2002, she presented in shock after experiencing cramping abdominal pain and passage of large bloody stools. Patient 2 was a 38-year-old male with 26 years of type I diabetes, who had a pancreas-kidney transplant in 1998, which was complicated by rejection of the kidney and pancreas in early 2003. He presented in late 2003 with a single episode of coffee-ground emesis and two episodes of brisk hematochezia. Investigation: Arterial angiography. Diagnosis: Pseudoaneurysm and small-bowel fistula from the arterial supply to the transplanted pancreas. Management: Angiographic embolization of the aneurysmal vessel and fistula achieved hemostasis. Patient 1 did not have her transplanted organ surgically removed and suffered a recurrent massive lower gastrointestinal bleed that proved fatal. In Patient 2, subsequent surgery and removal of ther rejected pancreas was performed and the patient continues to do well.