A 41-year-old woman with cirrhosis of the liver was admitted to our hospital because of a severe melena. Blood pool scanning with labelled red blood cells showed a high concentration in the right upper quadrant of the abdomen. Endoscopy of the second portion of the duodenum revealed fresh blood on the first examination and varices with overlying erosion were evident in the second study. Co-existent esophageal varices were present but were apparently not associated with the bleeding. Because of the continuous hypotension even with blood replacement, ligation and sclerotherapy were performed. To evaluate the efficacy of the procedures, intraoperative two-dimensional Doppler echography was used and the transducer was applied directly to the viscera. Blood flow was visualized in the serosal and submucosal varices. After ligation and sclerosing of the veins, the blood flow velocity signals disappeared. This woman died of multiple organ failure on the ninth postoperative day.
Real-time two-dimensional Doppler echography (2-D Doppler), which permits both structural and blood flow evaluations simultaneously, was applied during hepatectomy in three cases. Intrahepatic portal flow was observed in one case both before and after Pringle's maneuver. Hemihepatic blood flow interruption, which was guided by 2-D Doppler imaging, was tried in two cases. Extrahepatic blood flow was also detected easily with 2-D Doppler techniques. This approach is useful for both anatomic and hemodynamic evaluation during hepatic surgery.
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