title: Multivisceral transplantation for diffuse portomesenteric thrombosis in a patient with life-threatening esophagogastroduodenal bleeding.
abstract: Portal vein thrombosis is the most common cause of portal hypertension in noncirrhotic patients. Variceal bleeding is difficult to treat in these patients, especially those with prehepatic diffuse portal mesenteric thrombosis. In a patient with refractory esophagogastroduodenal variceal bleeding as a result of diffuse portomesenteric thrombosis and portal hypertension, life-threatening bleeding was unresponsive to endoscopic therapy and other surgical procedures. A multivisceral transplant was performed. It was curative and also lifesaving. There is only one report in the literature mentioning multivisceral transplantation for a patient with life-threatening esophagogastroduodenal bleeding; however that patient had protein C deficiency. Our patient had normal liver and intestinal function tests and no signs of hypercoagulable disease. We believe that multivisceral transplantation should be considered as a treatment option for patients with diffuse mesenteric thrombosis, even in the absence of liver and intestinal failure, when other treatment options for variceal bleeding have failed, particularly in a younger patient with a relatively good nutritional status before transplantation.
authors.affiliation: Division of Transplantation, Department of Surgery, Indiana University, Indianapolis, IN 46202-5149, USA. rvianna@iupui.edu
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Vianna
authors.forename: Rafael O
authors.initials: RO
authors.lastname: Giovanardi
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Fridell
authors.forename: Alfred Joseph
authors.initials: AJ
authors.lastname: Tector
mesh_terms: D000328:Adult; D000792:Angiography; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D007421:Intestine, Small / Q000637:transplantation; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D008642:Mesenteric Veins; D016035:Pancreas Transplantation; D011169:Portal Vein; D013270:Stomach / Q000637:transplantation; D020246:Venous Thrombosis / Q000150:complications* / Q000175:diagnosis; D014781:Viscera / Q000637:transplantation*