Caution for living donor liver transplantation with congenital portosystemic shunt: a case report
Abstract Background Congenital portosystemic shunt is an infrequent abnormal connection between the portal vascular system and the systemic circulation. Portosystemic shunts are common findings in patients with cirrhosis, causing gastroesophageal varices, hepatic encephalopathy, and others. However,...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-10-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-022-01533-3 |
| _version_ | 1797996115562332160 |
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| author | Yoshihiro Nagao Katsuya Toshida Akinari Morinaga Takahiro Tomiyama Yukiko Kosai Tomonari Shimagaki Takahiro Tomino Huanlin Wang Takeshi Kurihara Takeo Toshima Kazutoyo Morita Shinji Itoh Noboru Harada Tomoharu Yoshizumi |
| author_facet | Yoshihiro Nagao Katsuya Toshida Akinari Morinaga Takahiro Tomiyama Yukiko Kosai Tomonari Shimagaki Takahiro Tomino Huanlin Wang Takeshi Kurihara Takeo Toshima Kazutoyo Morita Shinji Itoh Noboru Harada Tomoharu Yoshizumi |
| author_sort | Yoshihiro Nagao |
| collection | DOAJ |
| description | Abstract Background Congenital portosystemic shunt is an infrequent abnormal connection between the portal vascular system and the systemic circulation. Portosystemic shunts are common findings in patients with cirrhosis, causing gastroesophageal varices, hepatic encephalopathy, and others. However, there is no consensus or literature describing how to manage asymptomatic patients with portosystemic shunts and normal liver. Case presentation The patient was a 39-year-old female who underwent donor right hepatectomy for living donor liver transplantation. The patient was healthy by nature, however, developed hepatic encephalopathy after the surgery due to a development of portosystemic shunt. Portosystemic shunt stole portal blood flow, and imaging modalities revealed narrowing of the portal trunk, representing prolonged depletion of portal blood flow. Balloon-occluded retrograde transvenous obliteration (B-RTO) was performed for occlusion of the portosystemic shunt. B-RTO increased portal blood flow, and hepatic encephalopathy with hyperammonemia was successfully resolved without the outbreak of any other symptom of portal hypertension. Conclusions A congenital portosystemic shunt itself is not a contraindication for donor hepatectomy, but perioperative endovascular shunts occlusion or intraoperative ligature of these shunts should be considered. |
| first_indexed | 2024-04-11T10:12:23Z |
| format | Article |
| id | doaj.art-003e44445a804e8c93ba95950e71e181 |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-04-11T10:12:23Z |
| publishDate | 2022-10-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj.art-003e44445a804e8c93ba95950e71e1812022-12-22T04:30:04ZengSpringerOpenSurgical Case Reports2198-77932022-10-01811510.1186/s40792-022-01533-3Caution for living donor liver transplantation with congenital portosystemic shunt: a case reportYoshihiro Nagao0Katsuya Toshida1Akinari Morinaga2Takahiro Tomiyama3Yukiko Kosai4Tomonari Shimagaki5Takahiro Tomino6Huanlin Wang7Takeshi Kurihara8Takeo Toshima9Kazutoyo Morita10Shinji Itoh11Noboru Harada12Tomoharu Yoshizumi13Department of Advanced Medical Initiatives, Kyushu University HospitalDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityDepartment of Surgery and Science, Graduate School of Medical Sciences, Kyushu UniversityAbstract Background Congenital portosystemic shunt is an infrequent abnormal connection between the portal vascular system and the systemic circulation. Portosystemic shunts are common findings in patients with cirrhosis, causing gastroesophageal varices, hepatic encephalopathy, and others. However, there is no consensus or literature describing how to manage asymptomatic patients with portosystemic shunts and normal liver. Case presentation The patient was a 39-year-old female who underwent donor right hepatectomy for living donor liver transplantation. The patient was healthy by nature, however, developed hepatic encephalopathy after the surgery due to a development of portosystemic shunt. Portosystemic shunt stole portal blood flow, and imaging modalities revealed narrowing of the portal trunk, representing prolonged depletion of portal blood flow. Balloon-occluded retrograde transvenous obliteration (B-RTO) was performed for occlusion of the portosystemic shunt. B-RTO increased portal blood flow, and hepatic encephalopathy with hyperammonemia was successfully resolved without the outbreak of any other symptom of portal hypertension. Conclusions A congenital portosystemic shunt itself is not a contraindication for donor hepatectomy, but perioperative endovascular shunts occlusion or intraoperative ligature of these shunts should be considered.https://doi.org/10.1186/s40792-022-01533-3Balloon-occluded retrograde transvenous obliterationDonor hepatectomyHyperammonemiaPortal blood flowPortosystemic shunt |
| spellingShingle | Yoshihiro Nagao Katsuya Toshida Akinari Morinaga Takahiro Tomiyama Yukiko Kosai Tomonari Shimagaki Takahiro Tomino Huanlin Wang Takeshi Kurihara Takeo Toshima Kazutoyo Morita Shinji Itoh Noboru Harada Tomoharu Yoshizumi Caution for living donor liver transplantation with congenital portosystemic shunt: a case report Surgical Case Reports Balloon-occluded retrograde transvenous obliteration Donor hepatectomy Hyperammonemia Portal blood flow Portosystemic shunt |
| title | Caution for living donor liver transplantation with congenital portosystemic shunt: a case report |
| title_full | Caution for living donor liver transplantation with congenital portosystemic shunt: a case report |
| title_fullStr | Caution for living donor liver transplantation with congenital portosystemic shunt: a case report |
| title_full_unstemmed | Caution for living donor liver transplantation with congenital portosystemic shunt: a case report |
| title_short | Caution for living donor liver transplantation with congenital portosystemic shunt: a case report |
| title_sort | caution for living donor liver transplantation with congenital portosystemic shunt a case report |
| topic | Balloon-occluded retrograde transvenous obliteration Donor hepatectomy Hyperammonemia Portal blood flow Portosystemic shunt |
| url | https://doi.org/10.1186/s40792-022-01533-3 |
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