Asymptomatic hepatic artery dissection early after living-donor liver transplantation with simultaneous splenectomy: two case reports
Abstract Background Hepatic artery dissection after liver transplantation is an uncommon morbidity. The onset mechanism and management for this disorder remain unclear. The present report describes the cases of two patients with hepatic artery dissection after living-donor liver transplantation (LDL...
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| Format: | Article |
| Language: | English |
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BMC
2020-11-01
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| Series: | BMC Gastroenterology |
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| Online Access: | http://link.springer.com/article/10.1186/s12876-020-01528-0 |
| _version_ | 1819169740602474496 |
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| author | Keita Shimata Yasuhiko Sugawara Tomoaki Irie Yuzuru Sambommatsu Masashi Kadohisa Sho Ibuki Seiichi Kawabata Kaori Isono Masaki Honda Hidekazu Yamamoto Taizo Hibi |
| author_facet | Keita Shimata Yasuhiko Sugawara Tomoaki Irie Yuzuru Sambommatsu Masashi Kadohisa Sho Ibuki Seiichi Kawabata Kaori Isono Masaki Honda Hidekazu Yamamoto Taizo Hibi |
| author_sort | Keita Shimata |
| collection | DOAJ |
| description | Abstract Background Hepatic artery dissection after liver transplantation is an uncommon morbidity. The onset mechanism and management for this disorder remain unclear. The present report describes the cases of two patients with hepatic artery dissection after living-donor liver transplantation (LDLT) with simultaneous splenectomy and provides new insight into the onset mechanism of this disorder. Case presentation: Case 1 A 51-year-old man with liver cirrhosis caused by hepatitis B virus underwent LDLT with a right lobe graft and splenectomy simultaneously. The recipient’s right hepatic artery had partial dissection at the anastomosis site; therefore, his left hepatic artery was anastomosed. Contrast-enhanced computed tomography (CT) on postoperative day (POD) 27 showed dissection from his celiac artery to his left hepatic artery with bleeding in the false lumen. There was a risk of rupture of the false lumen; therefore, emergency interventional radiology and coil embolization of the false lumen were performed. The patient was doing well at 6 months after LDLT. Case 2 A 58-year-old woman with liver cirrhosis caused by primary biliary cholangitis underwent LDLT with a left lobe graft and splenectomy simultaneously. Her hepatic artery had a dissection that extended from her left hepatic artery to the proper hepatic artery. The gastroduodenal artery was anastomosed. Contrast-enhanced CT on POD 8 revealed dissection from the celiac artery to the common hepatic artery as well as a pseudoaneurysm at the celiac artery. We managed the patient with conservative treatment and performed daily follow-ups with Doppler ultrasonography examination and serial contrast-enhanced CT. At the time of writing this report, the patient was doing well at 34 months after LDLT. Conclusions Patients who have an intimal dissection at the anastomosis site and/or simultaneous splenectomy are at a higher risk of hepatic artery dissection. Most patients with asymptomatic hepatic artery dissections can be treated conservatively. Blood flow in the intrahepatic artery should be checked frequently using Doppler ultrasonography or contrast-enhanced CT soon after diagnosis. |
| first_indexed | 2024-12-22T19:24:18Z |
| format | Article |
| id | doaj.art-53e7f7bac42843f998c91f2de1660503 |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-22T19:24:18Z |
| publishDate | 2020-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-53e7f7bac42843f998c91f2de16605032022-12-21T18:15:17ZengBMCBMC Gastroenterology1471-230X2020-11-012011910.1186/s12876-020-01528-0Asymptomatic hepatic artery dissection early after living-donor liver transplantation with simultaneous splenectomy: two case reportsKeita Shimata0Yasuhiko Sugawara1Tomoaki Irie2Yuzuru Sambommatsu3Masashi Kadohisa4Sho Ibuki5Seiichi Kawabata6Kaori Isono7Masaki Honda8Hidekazu Yamamoto9Taizo Hibi10Department of Transplantation and Pediatric Surgery, Kumamoto University HospitalDepartment of Transplantation and Pediatric Surgery, Kumamoto University HospitalDepartment of Transplantation and Pediatric Surgery, Kumamoto University HospitalDepartment of Transplantation and Pediatric Surgery, Kumamoto University HospitalDepartment of Transplantation and Pediatric Surgery, Kumamoto University HospitalDepartment of Transplantation and Pediatric Surgery, Kumamoto University HospitalDepartment of Transplantation and Pediatric Surgery, Kumamoto University HospitalDepartment of Transplantation and Pediatric Surgery, Kumamoto University HospitalDepartment of Transplantation and Pediatric Surgery, Kumamoto University HospitalDepartment of Transplantation and Pediatric Surgery, Kumamoto University HospitalDepartment of Transplantation and Pediatric Surgery, Kumamoto University HospitalAbstract Background Hepatic artery dissection after liver transplantation is an uncommon morbidity. The onset mechanism and management for this disorder remain unclear. The present report describes the cases of two patients with hepatic artery dissection after living-donor liver transplantation (LDLT) with simultaneous splenectomy and provides new insight into the onset mechanism of this disorder. Case presentation: Case 1 A 51-year-old man with liver cirrhosis caused by hepatitis B virus underwent LDLT with a right lobe graft and splenectomy simultaneously. The recipient’s right hepatic artery had partial dissection at the anastomosis site; therefore, his left hepatic artery was anastomosed. Contrast-enhanced computed tomography (CT) on postoperative day (POD) 27 showed dissection from his celiac artery to his left hepatic artery with bleeding in the false lumen. There was a risk of rupture of the false lumen; therefore, emergency interventional radiology and coil embolization of the false lumen were performed. The patient was doing well at 6 months after LDLT. Case 2 A 58-year-old woman with liver cirrhosis caused by primary biliary cholangitis underwent LDLT with a left lobe graft and splenectomy simultaneously. Her hepatic artery had a dissection that extended from her left hepatic artery to the proper hepatic artery. The gastroduodenal artery was anastomosed. Contrast-enhanced CT on POD 8 revealed dissection from the celiac artery to the common hepatic artery as well as a pseudoaneurysm at the celiac artery. We managed the patient with conservative treatment and performed daily follow-ups with Doppler ultrasonography examination and serial contrast-enhanced CT. At the time of writing this report, the patient was doing well at 34 months after LDLT. Conclusions Patients who have an intimal dissection at the anastomosis site and/or simultaneous splenectomy are at a higher risk of hepatic artery dissection. Most patients with asymptomatic hepatic artery dissections can be treated conservatively. Blood flow in the intrahepatic artery should be checked frequently using Doppler ultrasonography or contrast-enhanced CT soon after diagnosis.http://link.springer.com/article/10.1186/s12876-020-01528-0Hepatic artery dissectionLiving donor liver transplantationSplenectomyIntimal dissectionCase report |
| spellingShingle | Keita Shimata Yasuhiko Sugawara Tomoaki Irie Yuzuru Sambommatsu Masashi Kadohisa Sho Ibuki Seiichi Kawabata Kaori Isono Masaki Honda Hidekazu Yamamoto Taizo Hibi Asymptomatic hepatic artery dissection early after living-donor liver transplantation with simultaneous splenectomy: two case reports BMC Gastroenterology Hepatic artery dissection Living donor liver transplantation Splenectomy Intimal dissection Case report |
| title | Asymptomatic hepatic artery dissection early after living-donor liver transplantation with simultaneous splenectomy: two case reports |
| title_full | Asymptomatic hepatic artery dissection early after living-donor liver transplantation with simultaneous splenectomy: two case reports |
| title_fullStr | Asymptomatic hepatic artery dissection early after living-donor liver transplantation with simultaneous splenectomy: two case reports |
| title_full_unstemmed | Asymptomatic hepatic artery dissection early after living-donor liver transplantation with simultaneous splenectomy: two case reports |
| title_short | Asymptomatic hepatic artery dissection early after living-donor liver transplantation with simultaneous splenectomy: two case reports |
| title_sort | asymptomatic hepatic artery dissection early after living donor liver transplantation with simultaneous splenectomy two case reports |
| topic | Hepatic artery dissection Living donor liver transplantation Splenectomy Intimal dissection Case report |
| url | http://link.springer.com/article/10.1186/s12876-020-01528-0 |
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