Simultaneous pancreas-kidney (SPK) transplantation is a surgical treatment for patients with long-standing type 1 diabetes mellitus who consequently develop diabetic nephropathy and end-stage renal disease. Well-documented complications of pancreas transplant surgery include acute rejection, chronic rejection, pancreatitis, graft thrombosis, hemorrhage, anastomotic leakage, and intra-abdominal infection. However, small bowel obstruction (SBO), either through internal hernias or adhesive bands, can also occur. Our report details the case of a patient with a history of SPK transplantation 1.5 years earlier, presenting with peritonitis on examination and CT imaging concerning for a closed-loop SBO between the pancreatic allograft and small bowel mesentery. The patient successfully underwent laparoscopic management with laparoscopic small bowel resection and primary anastomosis.
Roberts et al. (2026) studied this question.