title: A patient with hepatic artery thrombosis after living-donor liver transplantation survived the great East Japan earthquake 3 days after reoperation: a case report.
abstract: BACKGROUND
  On March 11, 2011, our hospital was severely damaged by the Great East Japan Earthquake. We report the rare case of a 5-month-old patient with hepatic artery thrombosis (HAT) after living donor liver transplantation (LDLT), who survived the earthquake that occurred 3 days after the reoperation; we were able to save this patient without abilities to perform blood tests or computed tomography (CT) for 4 days.
  
  
  METHODS
  This female infant with biliary atresia underwent LDLT 5 months after birth and developed peritonitis owing to perforation of the small intestine 7 days later. Her blood pressure decreased and she developed HAT. We performed emergency reconstruction of the hepatic artery and repair of the small intestine, and 3 days after surgery, the Great East Japan Earthquake occurred.
  
  
  RESULTS
  We could not perform blood tests or CT scans because the water supply was damaged. Gas supply lines were also damaged and sterilization was not possible; surgical tools were limited. However, emergency power was available, so we performed ultrasonography every 6 hours and predicted liver function from intrahepatic blood flow and monitored for Glisson's capsule edema. The blood examination system recovered 14 days after LDLT, and we confirmed improvement of liver function. The patient was extubated 37 days after LDLT and discharged on postoperative day 67.
  
  
  CONCLUSIONS
  Portable ultrasonography was useful in evaluating intrahepatic blood flow and Glisson's capsule edema. Furthermore, it was effective during a disaster because it required no water or gas.
authors.affiliation: Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University, Sendai, Japan. msmsmiyagi@yahoo.co.jp
authors.forename: S
authors.initials: S
authors.lastname: Miyagi
authors.forename: N
authors.initials: N
authors.lastname: Kawagishi
authors.forename: K
authors.initials: K
authors.lastname: Satoh
authors.forename: S
authors.initials: S
authors.lastname: Sekiguchi
authors.forename: N
authors.initials: N
authors.lastname: Ohuchi
authors.forename: S
authors.initials: S
authors.lastname: Satomi
mesh_terms: D055866:Earthquakes; D005260:Female; D006499:Hepatic Artery / Q000473:pathology*; D006801:Humans; D007223:Infant; D007564:Japan; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D013927:Thrombosis / Q000150:complications*