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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (5): 902-907. doi: 10.19723/j.issn.1671-167X.2024.05.023

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Diagnosis and treatment of gastrointestinal bleeding after kidney transplantation

Handong DING1, Qin WANG2, Guiyi LIAO1,*(), Zongyao HAO1,*()   

  1. 1. Department of Urology, The First Affiliated Hospital of Anhui Medical University; Institute of Urology, Anhui Medical University; Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Hefei 230022, China
    2. Department of Pharmacy, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
  • Received:2021-07-12 Online:2024-10-18 Published:2024-10-16
  • Contact: Guiyi LIAO, Zongyao HAO E-mail:liaoguiyi2@sina.com;haozongyao2@163.com
  • Supported by:
    the Natural Science Foundation of Anhui Province(1508085SMH226)

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Abstract:

Objective: To analyze the clinical characteristics of acute and chronic gastrointestinal bleeding in patients with end-stage renal disease (ESRD) after kidney transplantation, to improve the understanding of the causes, diagnosis, treatment and prevention of this complication, and to improve the management of patients with gastrointestinal bleeding after kidney transplantation. Methods: The clinical, imaging and pathological data of patients with gastrointestinal bleeding after kidney transplantation in the Department of Urology of The First Affiliated Hospital of Anhui Medical University from August, 2015 to December, 2020 were collected. The etiology, early clinical manifestations, abnormal laboratory tests and examinations, treatment procedures, late prevention and treatment measures and outcomes of gastrointestinal bleeding were retrospectively studied, and the relevant literature was summarized and reviewed. Results: A total of 17 patients were included in this study. Nine patients had chronic small amount of bleeding, hemoglobin gradually decreased, melena and fecal occult blood positive in the early stage, and the general condition was good, vital signs were stable, and were cured by drug treatment. Gastroscopy showed small ulcers with active bleeding foci in 2 cases, and the bleeding was stopped by titanium clips, and the prognosis was good. Gastroscopy showed that the anterior wall longitudinal ulcer at the junction of gastric antrum body was not effective in 1 case, and the small branch of right gastroepithelial artery was embolized, and the patient recovered and discharged after 2 weeks. Gastroscopy showed deep pit ulcer at the lesser curvature of gastric antrum in 1 patient, who underwent distal gastroduodenal artery embolization and had a good prognosis. Gastroscopy showed huge multiple ulcers in the stomach and duodenal bulb in 2 patients, who underwent subtotal gastrectomy and partial duodenectomy, duodenal stump exclusion and remnant gastrojejunostomy. One patient recovered and was discharged, and the other patient died of rebleeding on the 12th day after surgery. Two cases of diverticulum underwent surgical resection of diverticulum, and the prognosis was good. Conclusion: The onset of gastrointestinal hemorrhage in kidney transplant patients is insidious, and the condition is acute or slow, which can cause different degrees of damage to the patient and the transplanted kidney. Active prevention, early diagnosis, timely drug treatment, if the effect is not good, decisive endoscopic titanium clip hemostasis, transvascular interventional embolization, and even surgical treatment can minimize the harm of gastrointestinal bleeding.

Key words: Kidney transplantation, Gastrointestinal bleeding, Hemodialysis

CLC Number: 

  • R692.5

Figure 1

Comparison of two patients with gastrointestinal bleeding before and after clipping with titanium clips under direct gastroscopy A, point of hemorrhage at the descending junction of the sphere; B, ball drop after titanium clip clamping; C, point of hemorrhage in the bulb; D, after titanium clip clamping of the ball."

Figure 2

Treatment course of a longitudinal anterior wall ulcer at the junction of the antrum body A, gastric body hemorrhage; B, titanium clip clipping; C, rebleeding right gastroepiploic artery; D, reinterventional embolization of right gastroepiploic artery."

Figure 3

Endoscopic findings of a deep pit ulcer in the lesser curvature of the antrum and the course of treatment A, gastric antral ulcer; B, gastric antral ulcer after cleaning; C, distal gastroduodenal artery bleeding point; D, distal gastroduodenal artery bleeding point after interventional embolization. Arrow show the bleeding point."

Figure 4

Gastroscopy showed multiple ulcerations in the stomach and descending part of the duodenal bulb A, ulcer in the descending duodenum; B, bleeding in the descending duodenal junction; C, after titanium clip clamping of the descending duodenal junction; D, ulcer in the duodenal bulb; E, ulcer in the gastric antrum; F, ulcer in the greater curvature of the gastric antrum."

Figure 5

Tissue specimens and pathology of two diverticula after surgical resection A, outside view of the ileocecal diverticulum; B, inside view of the ileocecal diverticulum; C, pathology of the ileocecal diverticulum(HE ×40);D, enteroscopy showing multiple ileocecal diverticulum; E, inside view of the ileocecal diverticulum; F, pathology of the ileocecal diverticulum(HE ×100)."

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