Aortic Graft Mycotic Pseudoaneurysm as a Severe Complication After Multivisceral Transplantation: A Case Report.
BACKGROUND
Surgical complications in multivisceral transplantation (MVT) are frequent and always severe. Those related to technical issues are relevant as they have implications not only on the graft but also on patient survival. The aim of this study was to review our case-based data and experience with 5 MVT performed since December 2004.


METHODS
A 38 year-old woman presented with ultra-short bowel syndrome due to massive ischemia also affecting the celiac trunk. She also had moderate to severe hepatitis/steatosis with some degree of fibrosis on liver biopsy, due to long-term home parenteral nutrition (HPN). An MVT was carried out in September 2010 including the liver, stomach, pancreatoduodenal complex with the spleen, and small bowel. The postoperative course was complicated by a leak from the pyloromiotomy, requiring reoperation on postoperative day 13. She also had central line catheter infection and renal impairment, requiring renal replacement therapy, and was discharged on postoperative day 150. Fifteen days later she was hospitalized because of severe abdominal pain associated with an abdominal mass. Computed tomography showed an aortic donor graft pseudoaneurysm, so we decided to operate on the patient. A complete resection of the pseudoaneurysm using an interposed polytetrafluoroethylene graft was performed. Six months after the MVT, the patient died due to sepsis, despite a functional graft and complete digestive autonomy.


CONCLUSIONS
Although this complication is rare, surgical complications in MVT are severe and may seriously impair graft and patient survival.
Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain. Electronic address: jcalvopulido@outlook.es.
J
J
Calvo Pulido
Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain.
M
M
Manrique Municio
Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain.
C
C
Loinaz Segurola
Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain.
I
I
Justo Alonso
Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain.
O
O
Caso Maestro
Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain.
A
A
García-Sesma
Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain.
F
F
Cambra Molero
Unit of Infectious Diseases, University Hospital 12 de Octubre, Madrid, Spain.
R
R
San-Juan Garrido
Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain.
M
M
Abradelo de Usera
Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain.
A
A
Marcacuzco Quinto
Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain.
E
E
Moreno González
Department of Transplant Surgery, University Hospital 12 de Octubre, Madrid, Spain.
C
C
Jiménez Romero
D000328:Adult; D017541:Aneurysm, False / Q000209:etiology / Q000382:microbiology / Q000601:surgery*; D000785:Aneurysm, Infected / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D001807:Blood Vessel Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000637:transplantation*; D016031:Liver Transplantation / Q000009:adverse effects*; D012086:Reoperation; D012778:Short Bowel Syndrome / Q000601:surgery*