title: Hepatic venous outflow obstruction after living donor liver transplantation managed with ectopic placement of a foley catheter: A case report.
abstract: BACKGROUND
  The early hepatic venous outflow obstruction (HVOO) is a rare but serious complication after liver transplantation, which may result in graft loss. We report a case of early HVOO after living donor liver transplantation, which was managed by ectopic placement of foley catheter.
  
  
  METHODS
  A 51 years old male patient with end stage liver disease received a right hemi-liver graft. On the first postoperative day the patient developed impairment of the liver functions. Doppler ultrasound (US) showed absence of blood flow in the right hepatic vein without thrombosis. The decision was to re-explore the patient, which showed torsion of the graft upward and to the right side causing HVOO. This was managed by ectopic placement of a foley catheter between the graft and the diaphragm and the chest wall. Gradual deflation of the catheter was gradually done guided by Doppler US and the patient was discharged without complications.
  
  
  CONCLUSIONS
  Mechanical HVOO results from kinking or twisting of the venous anastomosis due to anatomical mismatch between the graft and the recipient abdomen. It should be managed surgically by repositioning of the graft or redo of venous anastomosis. Several ideas had been suggested for repositioning and fixation of the graft by the use of Sengstaken-Blakemore tubes, tissue expanders, and surgical glove expander.
  
  
  CONCLUSIONS
  We report the use of foley catheter to temporary fix the graft and correct the HVOO. It is a simple and safe way, and could be easily monitored and removed under Doppler US without any complications.
authors: Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt.
authors: Mohamed Abdel
authors: MA
authors: Wahab
authors: Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt. Electronic address: ahmedshehta@mans.edu.eg.
authors: Ahmed
authors: A
authors: Shehta
authors: Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt.
authors: Hosam
authors: H
authors: Hamed
authors: Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt.
authors: Mohamed
authors: M
authors: Elshobary
authors: Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt.
authors: Tarek
authors: T
authors: Salah
authors: Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt.
authors: Ahmed Mohamed
authors: AM
authors: Sultan
authors: Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt.
authors: Omar
authors: O
authors: Fathy
authors: Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt.
authors: Ahmed
authors: A
authors: Elghawalby
authors: Liver Transplantation Unit, Gatroenterology Surgical Center, College of Medicine, Mansoura University, Egypt.
authors: Amr
authors: A
authors: Yassen
authors: Radiology Department, Gatroenterology Surgical Center, Mansoura University, Egypt.
authors: Usama
authors: U
authors: Shiha
keywords: Foley catheter; Liver transplantation; Venous outflow obstruction