Successful laparoscopic-assisted hemostasis of intrathoracic massive vericeal rupture during living related liver transplantation: a case report.
Transplant Proc
; 44(3): 820-1, 2012 Apr.
Article
en En
| MEDLINE
| ID: mdl-22483505
End-stage liver disease that requires transplantation is usually accompained by esophagogastric or another collateral vessel varices. Sometimes, the esophagogastric varices rupture intraoperatively during liver transplantation. However we have reported rare case of rupture of an intercostal varicose vein, which was controlled successfully by flexible laparoscopy. The patient was a 62-year-old man, who suffered decompensated liver cirrhosis with hepatocellular carcinoma. The Child-Pugh score was 11 and the Model for End-stage Liver Diseases score was 14. Preoperative gastrointestinal fiberscopy and colon fiberscopy examinations revealed esophagogastric and rectal varices. He underwent living related liver transplantation from his son on February 10, 2010. Just after the liver transplantation, the patient's blood pressure tended to decrease. Chest radiography demonstrated a massive right pleural effusion. We drained 3000 mL of blood by thoracic puncture. Therefore we reoperated him for the question an intrathoracic variceal hemorrhage. We confirmed variceal bleeding after removal of the massive hematoma by opening the diaphragm. However, we could neigher show directly the bleeding point in the anterior thorax nor stop it because of the constriction of the diaphragm. Therefore we used a flexible laparoscope to both confirm the bleeding point and to achieve hemostasis. We believe that theoperative compression of the intercostal varicose vein by a retractor induced the vascular rupture.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Várices
/
Trasplante de Hígado
/
Laparoscopía
/
Donadores Vivos
/
Hemostasis
Tipo de estudio:
Prognostic_studies
Límite:
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Transplant Proc
Año:
2012
Tipo del documento:
Article
País de afiliación:
Japón
Pais de publicación:
Estados Unidos