Pancreas Transplant Salvage by Proximal Loop Ileostomy and Distal Ileostotomy Tube for Duodenal Stump Leak after Enteric Conversion
Bibliographic record
Abstract
After pancreas transplantation, some patients with bladder drainage (BD) of the pancreatic duct will need to be converted to enteric drainage (ED) because of reflux pancreatitis, metabolic acidosis, and urological complications. However, ED is associated with higher rates of duodenal stump leak, intra-abdominal abscess, and peritonitis. In some cases of enteric anastomosis leakage, a primary repair can be attempted, but in more severe cases, graft pancreatectomy is indicated. We report one patient who received a combined kidney and pancreas transplant with BD of exocrine secretions, but who required ED conversion 6 years later because of persistent metabolic acidosis and adverse urological symptoms. However, a significant duodenal leak was discovered 4 days post-operatively. To salvage the transplanted pancreas, we performed a diverting loop ileostomy proximal to the entero-entero anastomosis and the distal section was drained retrogradely with an ileostostomy tube, allowing the area of the leak to heal. Three months later, the ileostomy was reversed without complications, the symptoms that led to the ED conversion resolved, and the kidney and pancreas allografts remain functional 48 months later. We suggest that this might be a method by which transplanted pancreas may be salvaged in the case of leakage after ED conversion.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".