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Recurrent portal hypertension after composite liver/small bowel transplantation.
- Source :
-
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2002 Jul; Vol. 8 (7), pp. 639-42. - Publication Year :
- 2002
-
Abstract
- 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.
- Subjects :
- Anastomosis, Surgical
Fatal Outcome
Female
Gastrointestinal Hemorrhage etiology
Graft Rejection
Humans
Hypersplenism etiology
Infant
Intestines blood supply
Liver Transplantation methods
Radiography
Recurrence
Splenorenal Shunt, Surgical
Thrombocytopenia etiology
Varicose Veins etiology
Vascular Diseases diagnostic imaging
Vascular Diseases etiology
Vena Cava, Inferior
Hypertension, Portal etiology
Intestines transplantation
Liver Transplantation adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1527-6465
- Volume :
- 8
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
- Publication Type :
- Academic Journal
- Accession number :
- 12089720
- Full Text :
- https://doi.org/10.1053/jlts.2002.33455