A complication of infrarenal arterial conduit following orthotopic liver transplant.

BACKGROUND: Thrombosis of the arterial inflow to a transplanted liver graft frequently leads to graft necrosis, and retransplantation is required. CASE OUTLINE: A 41-year-old man underwent orthotopic liver retransplantation. Arterial inflow to the graft was provided by an infrarenal arterial conduit. On day 14 he developed thrombosis of the conduit due to herniation of the jejunum between the conduit and the transverse mesocolon. Reduction of the herniated bowel and thrombectomy of the graft was initially successful, but he subsequently developed necrosis of segments II-V (diagnosed on computed tomography, CT). These segments were then resected, and thereafter his graft functioned well over the next 7 years. DISCUSSION: The potential space between an infrarenal arterial conduit and the transverse mesocolon must be eliminated to prevent incarceration of the intestine following liver transplantation. Early diagnosis of arterial thrombosis may allow revascularisation of the liver graft, but subsequent CT scanning is essential to assess the viability of the graft. Segmental graft necrosis may be managed by liver resection with good long-term results.