Contribution of contrast-enhanced ultrasonography to nonoperative management of segmental ischemia of the head of a pancreas graft.

A 32-year-old recipient of a pancreas transplant (PTx) alone was diagnosed with segmental graft ischemia, involving the head of the pancreas graft (HPG), based on color Doppler ultrasonography (CDU) and computed tomography (CT) angiography. For investigational purposes, graft supply was further checked by contrast-enhanced ultrasonography (CEU). Surprisingly, CEU showed collateral blood supply to the HPG starting from 40 s after contrast injection and resulting in homogenous parenchymography at 90 s. Full-dose heparin infusion, followed by long-term oral anticoagulation, allowed graft salvage without reoperation. At the longest follow-up of 18 months, the patient is insulin independent. This case report shows that CEU may be employed in PTx recipients suspected to harbor vascular complications. To the best of our knowledge, this is the first description of the use of CEU in PTx and the first description of graft salvage, without partial pancreatectomy after CDU and CT diagnosis of segmental graft ischemia.