[Early thrombosis of the portal vein after orthoptic liver transplantation. A case report].
We report on a case of early portal vein thrombosis occurring after liver transplantation in a patient with alcoholic cirrhosis. Although this complication is usually accompanied by acute graft failure and/or gastroesophageal bleeding, in this patient the portal thrombosis occurred with the appearance of general dropsy and encephalopathy, serum protein deficiency and a slight rise in liver function test values. Echo-Doppler and arteriography showed portal thrombosis, arterial hyperflow and the persistence of a large spontaneous spleno-renal shunt, identified before the transplant had taken place. Endoscopy did not reveal gastroesophageal varices. Since there was no sign of serious ischemic damage or of a serious deterioration of liver function, the patient was treated non-operatively. Some particular hemodynamic aspects implicated in the appearance of portal thrombosis in our case are discussed. However, the authors consider that spontaneous portal-systemic shunt, in the presence of advanced cirrhosis, inverted portal flow, without gastroesophageal varices, can be considered as a surgical total diverting shunt and should be taken as a risk for portal thrombosis after transplantation.
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Istituto di Clinica Chirurgica II, Università degli Studi di Bologna, Policlinico S. Orsola.
Bellusci
R
R
Gaiani
S
S
Cavallari
A
A
Gozzetti
G
G
D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D011170:Portasystemic Shunt, Surgical; D011183:Postoperative Complications / Q000175:diagnosis* / Q000601:surgery; D013927:Thrombosis / Q000175:diagnosis* / Q000601:surgery; D013997:Time Factors; D014184:Transplantation, Homologous
Trombosi precoce della vena porta dopo trapianto ortotopico di fegato. Descrizione di un caso.