title: Veno-atrial bypass for the operative treatment of septic gas gangrene secondary to delayed hepatic artery thrombosis.
abstract: The occurrence of late hepatic artery thrombosis after orthotopic liver transplantation can result in gas gangrene of the graft. This clinical scenario has the potential to be rapidly fatal as a result of fulminant hepatic failure, sepsis and multiple-organ-failure syndrome. Emergency operative intervention is indicated to remove the septic source and replace the failed liver. In this report, both cases demonstrated rapid deterioration within 24 h from the onset of symptoms, in spite of maximum supportive care. Intra-operative handling of the gangrenous graft resulted in hemodynamic instability and a technically unfeasible hepatectomy. The use of extra-corporeal veno-atrial bypass, by isolating the septic source, allowed for graft hepatectomy and successful re-transplantation in the second of these reported cases.
authors.affiliation: Department of Surgery, McGill Universiry Health Centre, Montreal, Quebec, Canada.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Chan
authors.forename: Jean
authors.initials: J
authors.lastname: Tchervenkov
authors.forename: Marcelo
authors.initials: M
authors.lastname: Cantarovich
authors.forename: Eliot
authors.initials: E
authors.lastname: Alpert
authors.forename: Marc
authors.initials: M
authors.lastname: Deschenes
authors.forename: Patrick
authors.initials: P
authors.lastname: Ergina
authors.forename: Peter
authors.initials: P
authors.lastname: Metrakos
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Barkun
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D005738:Gas Gangrene / Q000209:etiology* / Q000601:surgery*; D006499:Hepatic Artery / Q000473:pathology* / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D013927:Thrombosis / Q000150:complications* / Q000601:surgery