title: Severe outflow block syndrome caused by compression by the swollen caudate lobe after living donor liver transplantation: report of a case.
abstract: A 50-year-old man with primary biliary cirrhosis underwent living-donor liver transplantation (LDLT) using a graft of a left hemiliver with a left caudate lobe and duct-to-duct hepaticocholedochostomy. Postoperative bile leakage necessitated percutaneous drainage 22 days after LDLT. The patient presented to our hospital 205 days after the LDLT with abdominal distension and fever. Computed tomography showed ascites and a diffusely mottled pattern in the graft. The caudate lobe was swollen, and its bile ducts were dilated. The inferior vena cava was forced to the right by the swollen caudate lobe, and the root of the hepatic vein was stretched. The hepatic vein was not contrasted. Endoscopic retrograde cholangiography showed a biliary anastomotic stricture. Based on these findings, we diagnosed a severe outflow block of the hepatic vein and biliary anastomotic stricture. We performed balloon dilation of the biliary anastomosis and implanted a metallic stent in the hepatic vein. Thereafter, his clinical symptoms improved dramatically.
authors: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan. kazutake@yokohama-cu.ac.jp
authors: Kazuhisa
authors: K
authors: Takeda
authors: Kuniya
authors: K
authors: Tanaka
authors: Takafumi
authors: T
authors: Kumamoto
authors: Akimitsu
authors: A
authors: Yamada
authors: Michiyo
authors: M
authors: Yamada
authors: Hideki
authors: H
authors: Takakura
authors: Kensuke
authors: K
authors: Kubota
authors: Noritoshi
authors: N
authors: Kobayashi
authors: Jin
authors: J
authors: Lee
authors: Itaru
authors: I
authors: Endo
mesh_terms: D006502:Budd-Chiari Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D002404:Catheterization / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D004487:Edema / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D005500:Follow-Up Studies; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008099:Liver / Q000473:pathology* / Q000601:surgery; D008105:Liver Cirrhosis, Biliary / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012720:Severity of Illness Index; D015607:Stents; D014057:Tomography, X-Ray Computed