Liver transplant after massive spontaneous hepatic rupture in pregnancy complicated by preeclampsia
Autor: | Maureen Martin, Jo Ann Benda, Frank J. Zlatnik, Stephen K. Hunter |
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Rok vydání: | 1995 |
Předmět: |
Adult
medicine.medical_specialty medicine.medical_treatment Pregnancy Trimester Third Portacaval shunt Hemorrhage Liver transplantation Preeclampsia Liver disease Pre-Eclampsia Pregnancy medicine Hepatectomy Humans Rupture Spontaneous business.industry Portacaval Shunt Surgical Liver Diseases Obstetrics and Gynecology Total Hepatectomy medicine.disease Surgery Liver Transplantation Transplantation Liver Female Complication business |
Zdroj: | Obstetrics and gynecology. 85(5 Pt 2) |
ISSN: | 0029-7844 |
Popis: | Background : Spontaneous hepatic rupture associated with preeclampsia is a rare but life-threatening situation. Several different surgical treatments have been described, depending on the severity of the rupture. Liver transplantation has become the mainstay for patients with end-stage liver disease. Transplantation in the setting of liver trauma or massive parenchymal disruption is not well defined. To our knowledge, this treatment has not been reported for spontaneous hepatic rupture in pregnancy. Case : Massive, spontaneous hepatic rupture occurred in a patient at 36 weeks' gestation as a result of severe preeclampsia. Conventional surgical therapies were unsuccessful in controlling the massive hemorrhage. As a life-saving measure, the patient underwent total hepatectomy with the creation of an end-to-side portacaval shunt, thereby rendering the patient anhepatic. The patient was listed as urgently needing a liver for transplantation through the United Network for Organ Sharing. A suitable donor liver was located approximately 8 hours after the emergency hepatectomy. The patient underwent orthotopic liver transplantation after being maintained in an anhepatic state for almost 13 hours. The patient was discharged on postoperative day 41, suffering only from some ischemic lower extremity neuropathy secondary to hypovolemic hypotension occurring during the hepatectomy procedure. Conclusion : In the reported case, spontaneous hepatic rupture resulted in a massive hemorrhage that could not be controlled by previously reported techniques and required total hepatectomy followed by liver transplantation. |
Databáze: | OpenAIRE |
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