Recurrent portal hypertension after composite liver/small bowel transplantation
| Autor: | Stuart S. Kaufman, Gabriel Gondolesi, Thomas M. Fishbein, Neal S. Leleiko, Sander Florman, Harold A. Mitty, Allan Tschernia |
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| Rok vydání: | 2002 |
| Předmět: |
Graft Rejection
medicine.medical_specialty medicine.medical_treatment Portacaval shunt Vena Cava Inferior Liver transplantation Anastomosis Inferior vena cava Hypersplenism Varicose Veins Fatal Outcome Recurrence Occlusion Hypertension Portal medicine Humans Vascular Diseases Transplantation Hepatology business.industry Anastomosis Surgical Infant medicine.disease Thrombocytopenia Surgery Liver Transplantation Intestines Radiography Stenosis medicine.vein Portal hypertension Female business Gastrointestinal Hemorrhage Splenorenal Shunt Surgical |
| Zdroj: | Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 8(7) |
| ISSN: | 1527-6465 |
| Popis: | Late technical complications of composite liver/small bowel transplantation procedures are often complex and have not been well defined. Here we describe the unusual presentation and management of two cases of recurrent thrombocytopenia due to hypersplenism resulting from portacaval shunt stenosis. Both patients presented with portal hypertension late after composite liver/small bowel transplantation. One patient presented with recurrent bouts of upper gastrointestinal hemorrhage and was ultimately found to have a stenosis of her native portacaval shunt. After unsuccessful balloon dilatation of the anastomosis, a successful side-to-side distal splenorenal shunt was performed. The second patient presented with severe thrombocytopenia, the etiology of which was determined to be a short segment occlusion of the inferior vena cava between the native portacaval shunt and the piggyback outflow anastomosis of the liver graft. Total caval occlusion prevented balloon dilatation; the patient was relisted for transplantation but died of chronic rejection four months later. Recurrent portal hypertension is challenging in patients who have had combined liver/small bowel transplantation. Surgeons performing intestinal transplantation need to be increasingly aware of these possible late complications. |
| Databáze: | OpenAIRE |
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