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Spontaneous hepatic rupture after revascularization during liver transplantation

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Euroanaesthesia 2017

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Abstract

INTRODUCTION:Spontaneous hepatic rupture has been describe before in association with some conditions but there is only few cases in which a spontaneuos liver rupture during transplantation has been reported(1).We present one of these case, requiring total hepatectomy and portocaval shunt, followed by retransplatation. CASE REPORT:A 65 year-old man HVC positive with chronic hepatopathy,was admitted for a liver transplantation.The donor had a history of Chagas disease with normal liver function tests.After completing the caval and portal anastomosis, the liver was revascularized.Within minutes it developed multiple large subcapsular haematomas that spontaneously ruptured leading to an uncontrollable hemorrage.Despite all the efforts to stop the bleeding the liver continue to rupture, forcing the surgeons to perform an hepatectomy of the implanted liver and a portocaval anastomosis.The patient was taken to the ICU and was retransplanted 14 hours later. DISCUSSION:Spontaneous hepatic rupture is rare.The exact aetiology is not well understood(1).Because of this rare condition,no single institution has acumulated enough experience to make recommendations about treatment(2).In an unstable patient with rupture of the liver,operation is neccesary.Sometimes perihepatic packing, segmentectomy or hemihepatectomy are enough.In others the only treatment is total hepatectomy followed by trasplantation.Over the last years, the technique of venovenous bypass is become more selective. However it has been use in most of the cases during the anaepathic phase if the trasplantation was carried out in two phases(3).Our patient was not placed in bypass.The most common complications that could occur with this technique are those related with venous hypertension. REFERENCES: 1.Mistry,B.Spontaneous rupture of the liver upon revascularization during transplantation.Transplantation 2000;69:2214-2218. 2.Mascarenhas,R.Spontaneuos hepatic rupture: a report of five cases.HPB 2002;4(4):167-170. 3.Sanabria,R.Total hepatectomy and liver transplantation as a two-stage procedure for fulminant hepatic failure:A safe procedure in exceptional circumstances.World J Hepatol. 2016,8(4):226-230. LEARNING POINT:Selection of a suitable donor is one of the most important factors for a succesful outcome after trasplantation.Eventhough in our case a venovenous bypass was not used,it could be useful in order to decompress the systemic and portal venous systems and,reduce this way, the possible complications

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