Abstract
A 54-year-old male presented with acute rejection and life-threatening gastrointestinal bleeding 2 months following orthotopic liver transplantation. Since no bleeding was identified in the entire gastrointestinal (GI) tract, hematobilia was first suspected and an arteriocholedochal fistula angiographically confirmed. Two days after resection of a pseudoaneurysm of the hepatic artery (HA) with primary repair and closure of the bile duct fistula, hepatic artery thrombosis (HAT) occurred. Various attempts to revascularize the HA eventually failed. Two weeks later, a CT scan showed necrotic areas within the two left lateral segments. At relaparotomy, major parts of the bile duct were found to be necrotic, and the biliary anastomosis was therefore abandoned and necrotic tissue removed. HAT was otherwise well tolerated by the graft and, at a further relaparotomy some weeks later, a hepaticojejunostomy was performed. Two years after transplantation the patient is well with a normally functioning graft.
This is a preview of subscription content, log in via an institution to check access.
References
Blumhardt G, Ringe B, Lauchart W, Burdelski M, Bechstein WO, Pichlmayr R (1987) Vascular problems in liver transplantation Transplant Proc 19: 2412
Hesselink EJ, Klompmaker IJ, Grond J, Gouw ASH, Schilfgaarde R van, Slooff MJH (1989) Hepatic artery thrombosis (HAT) after orthotopic liver transplantation (OLT) — the influence of technical factors and rejection episodes Transplant Proc 21: 2468
Hesselink EJ, Klompmaker IJ, Pruim J, Schilfgaarde R van, Slooff MJH (1989) Hepatic artery thrombosis after orthotopic liver transplantation — a fatal complication or an asymptomatic event? Transplant Proc 21: 2462
Klintmalm GB, Olson LM, Nery JR, Husberg BS, Paulsen AW (1988) Treatment of hepatic artery thrombosis after liver transplantation with immediate vascular reconstruction: a report of three cases. Transplant Proc 20: 610–612
Klintmalm GBG, Olson LM, Paulsen AW, Whitten CW, Husberg BS (1988) Hepatic arterial thrombosis after liver transplantation: intraoperative electromagnetic blood flow evaluation. Transplant Proc 20: 616–618
Langnas AN, Wagner M, Stratta RJ, Wood RP, Li S, Shaw BW (1991) Hepatic allograft rescue following arterial thrombosis. Transplantation 51: 86–90
Madariaga J, Tzakis A, Zajko AB, Tzoracoleftherakis E, Tepetes K, Todo S Starzl TE (1992) Hepatic artery pseudoaneurysm ligation after orthotopic liver transplantation Transplantation 54: 824–828
Ringe B, Oldhafer K, Bunzendahl H, Bechstein WO, Kotzerke J, Pichlmayr R (1989) Analysis of biliary complications following orthotopic liver transplantation Transplant Proc 21: 2472–2476
Todo S, Makowka L, Tzakis AG, Marsh JW, Karrer FM, Armany M, Miller C, Tallent MB, Esquivel CO, Gordon RD, Iwatsuki S, Starzl TE (1987) Hepatic artery in liver transplantation Transplant Proc 19: 2406–2411
Tzakis AG, Gordon RD, Shaw BW, Iwatsuki S, Starzl TE (1985) Clinical presentation of hepatic artery thrombosis after liver transplantation in the cyclosporine era Transplantation 40: 667–671
Zajko AB, Tobben PJ, Esquivel CO, Starzl TE (1989) Pseudoaneurysm following orthotopic liver transplantation — clinical and radiologic manifestations. Transplant Proc 21: 2457–2459
Author information
Authors and Affiliations
About this article
Cite this article
Riedmann, B., Pernthaler, H., Königsrainer, A. et al. Life-threatening gastrointestinal bleeding after liver transplatation due to hepatic artery pseudoaneurysm perforating into the common bile duct. A case report. Transpl Int 8, 492–495 (1995). https://doi.org/10.1007/BF00335604
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00335604