Masashi Kadohisa1, Yukihiro Inomata2,3, Masataka Sakisaka2,4, Yasuhiko Sugawara2, Taizo Hibi2. 1. Department of Transplantation and Pediatric Surgery, Kumamoto University, Honjo 1-1-1, Chuo-Ku, Kumamoto-Shi, Kumamoto, 860-8556, Japan. kadohisa.masashi@kuh.kumamoto-u.ac.jp. 2. Department of Transplantation and Pediatric Surgery, Kumamoto University, Honjo 1-1-1, Chuo-Ku, Kumamoto-Shi, Kumamoto, 860-8556, Japan. 3. Kumamotorousai Hospital, Kumamoto, Japan. 4. Sakisaka Hospital, Kumamoto, Japan.
Abstract
BACKGROUND: The rupture of a hepatic artery pseudoaneurysm (HAP) is a rare but lethal complication after living donor liver transplantation (LDLT) and often manifests as acute gastrointestinal bleeding. CASE PRESENTATION: This report describes three patients who experienced HAP after LDLT. These patients initially presented with active bleeding of a duodenal ulcer (DU) in the duodenal bulb, followed by diagnosis of the ruptured HAP by angiography. None of the patients had evidence of an active intra-abdominal infection or bile leakage preceding the rupture of HAP. All patients were initially treated by transcatheter arterial coil embolization (TAE). In all cases, TAE was successful for hemostasis but resulted in complete obstruction of the arterial inflow to the graft. Arterial revascularization by surgical reconstruction using the autologous arterial graft in one case and re-LDLT in another one was successfully performed. The other one succumbed to sepsis caused by later liver abscesses. CONCLUSION: This is the first detailed case series of massive DU bleeding as a warning signal of ruptured HAP after LDLT. HAP should be included in the differential diagnosis when an LDLT recipient presents with gastrointestinal bleeding.
BACKGROUND: The rupture of a hepatic artery pseudoaneurysm (HAP) is a rare but lethal complication after living donor liver transplantation (LDLT) and often manifests as acute gastrointestinal bleeding. CASE PRESENTATION: This report describes three patients who experienced HAP after LDLT. These patients initially presented with active bleeding of a duodenal ulcer (DU) in the duodenal bulb, followed by diagnosis of the ruptured HAP by angiography. None of the patients had evidence of an active intra-abdominal infection or bile leakage preceding the rupture of HAP. All patients were initially treated by transcatheter arterial coil embolization (TAE). In all cases, TAE was successful for hemostasis but resulted in complete obstruction of the arterial inflow to the graft. Arterial revascularization by surgical reconstruction using the autologous arterial graft in one case and re-LDLT in another one was successfully performed. The other one succumbed to sepsis caused by later liver abscesses. CONCLUSION: This is the first detailed case series of massive DU bleeding as a warning signal of ruptured HAP after LDLT. HAP should be included in the differential diagnosis when an LDLT recipient presents with gastrointestinal bleeding.
Authors: Wael E A Saad; Niloy Dasgupta; Allison J Lippert; Ulku C Turba; Mark G Davies; Sean Kumer; Jason C Gardenier; Saher S Sabri; Auh-Whan Park; David L Waldman; Timothy Schmitt; Alan H Matsumoto; John F Angle Journal: Cardiovasc Intervent Radiol Date: 2012-05-31 Impact factor: 2.740
Authors: M E van Leerdam; E M Vreeburg; E A J Rauws; A A M Geraedts; J G P Tijssen; J B Reitsma; G N J Tytgat Journal: Am J Gastroenterol Date: 2003-07 Impact factor: 10.864