Hemobilia after mycotic hepatic artery pseudoaneurysm after liver transplantation

Leonardi, Luiz Sérgio; Soares, Ciro Dantas; Boin, I.F.S.F.; Oliveira, Vera Cecilia Sabino de

doi:10.1016/s0041-1345(01)02103-0

Cited by 18 publications

(11 citation statements)

References 9 publications

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“…Moreover, it is likely that cases with uncontrollable fatal hemorrhage have been underreported. Although not always detailed, the most frequent clinical presentation is hemoperitoneum (more than half of the patients in the present series), or gastrointestinal bleeding , with or without hemobila .…”

Section: Discussionmentioning

confidence: 81%

“…Posttransplant HA pseudoaneurysm is a rare event with an overall incidence ranging from 1% to 2% (3, 13, 14). Most of the previous series have reported various clinical presentations of posttransplant HA pseudoaneurysms and their subsequent management . In fact, HA pseudoaneurysms are characterized by great clinical heterogeneity, varying from incidental diagnosis on posttransplant imaging with hemodynamic stability allowing percutaneous stenting or surgical revision to massive bleeding leading to nearly instant death.…”

Section: Discussionmentioning

confidence: 99%

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Hepatic Artery Ligation for Arterial Rupture Following Liver Transplantation: A Reasonable Option

Boleslawski

Bouras

Truant

et al. 2013

American Journal of Transplantation

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Hepatic artery (HA) rupture after liver transplantation is a rare complication with high mortality. This study aimed to review the different managements of HA rupture and their results. From 1997 to 2007, data from six transplant centers were reviewed. Of 2649 recipients, 17 (0.64%) presented with HA rupture 29 days (2-92) after transplantation. Initial management was HA ligation in 10 patients, reanastomosis in three, aorto-hepatic grafting in two and percutaneous arterial embolization in one. One patient died before any treatment could be initiated. Concomitant biliary leak was present in seven patients and could be subsequently treated by percutaneous and/or endoscopic approaches in four patients. Early mortality was not observed in patients with HA ligation and occurred in 83% of patients receiving any other treatment. After a median follow-up of 70 months, 10 patients died (4 after retransplantation), and 7 patients were alive without retransplantation (including 6 with HA ligation). HA ligation was associated with better 3-year survival (80% vs. 14%; p = 0.002). Despite its potential consequences on the biliary tract, HA ligation should be considered as a reasonable option in the initial management for HA rupture after liver transplantation.Unexpectedly, retransplantation was not always necessary after HA ligation in this series.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Hepatic Artery Ligation for Arterial Rupture Following Liver Transplantation: A Reasonable Option

Boleslawski

Bouras

Truant

et al. 2013

American Journal of Transplantation

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“…Bile leak, biloma formation, and associated peritoneal infection are associated withand are a proposed mechanism for-pseudoaneurysm formation and hemobilia after cholecystectomy. Liver transplantation and pancreaticoduodenectomy (Whipple procedure) have also been reported to be complicated by hemobilia [32,[43][44][45][46][47]. Theoretically, the potential exists for hemobilia with any surgery of the hepatobiliary system.…”

Section: Cholecystectomy and Other Surgerymentioning

confidence: 99%

Hemobilia

Chin

Enns

2010

Curr Gastroenterol Rep

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Hemobilia is an uncommon medical problem that presents in a varied fashion and is increasingly of iatrogenic origin. The diagnosis of hemobilia needs to be considered in patients presenting with upper gastrointestinal bleeding, particularly if they are jaundiced with abdominal pain in the setting of recent or previous percutaneous liver intervention or abdominal trauma. Multislice computed tomographic angiography is increasingly being used in the investigation, but transcatheter arterial embolization remains the cornerstone of managing those patients requiring intervention. The majority of patients with hemobilia will be managed supportively or with radiologic intervention; most do not require surgical intervention.

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“…Its discovery may result from an evaluation of abdominal symptoms (patient 1), or it may be serendipitous (patient 2). Earlier presentations may be serendipitous as well (10,12), but also include fever (12); upper gastrointestinal hemorrhage (hemobilia or arterio-gastric/enteric fistula) (1,2,10,11,13,14); and intra-abdominal hemorrhage (1,2,4,6). The etiology of HAAs is less likely to be infectious in aneu-rysms discovered more than 2 months after transplantation (2), although it is possible they originate from an infectious cause which is subsequently cleared or that the intraoperative cultures are falsely negative.…”

Section: Vascular Homograft Use In Liver Transplantationmentioning

confidence: 99%

“…Potential surgical options to achieve revascularization include primary re-anastomosis after aneurysmectomy, which is not likely feasible with late HAAs, or the use of a vascular conduit. Available conduits in this situation include autologous saphenous vein (7,11,13,15), third-party cadaveric saphenous vein (12), arterial autografts, prosthetic conduits, and third-party arterial grafts as described above. Narumi et al (14) used a preserved homograft for arterial reconstruction following HAA resection 2 months after OLT, but the origin of the homograft and their preservation method were not stated.…”

Section: Vascular Homograft Use In Liver Transplantationmentioning

confidence: 99%

Use of Preserved Vascular Homografts in Liver Transplantation: Hepatic Artery Aneurysms and Other Complications

Sellers¹,

Haustein²,

McGuire

et al. 2002

American Journal of Transplantation

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Hepatic artery aneurysms/pseudoaneurysms (HAAs) are rare but serious complications after orthotopic liver transplantation (OLT). Revascularization should accompany aneurysmectomy if possible and is more feasible if the aneurysm presents late after transplantation. The optimal conduits for revascularization in this situation are not known. Two patients with hepatic artery aneurysms/pseudoaneurysms who had aneurysmectomy and revascularization with thirdparty cadaveric iliac arterial grafts 1 and 4 years after OLT are presented in detail, with an emphasis on the preservation method used for the grafts. Both livers were successfully revascularized with arterial grafts preserved for 21 and 26 days after procurement. Hepatic patency was documented in both 5 and 6 months after repair; graft function has remained normal 13 and 32 months after repair. Third-party vessels preserved for shorter periods have been used successfully in four other situations, including living-donor liver transplantation, and are briefly discussed. In conclusion, properly preserved vascular homografts are useful in LT for purposes other than initial vascular reconstruction. They also provide an excellent vascular conduit in recipients of livers from other (possibly living) donors.

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Hemobilia after mycotic hepatic artery pseudoaneurysm after liver transplantation

Cited by 18 publications

References 9 publications

Hepatic Artery Ligation for Arterial Rupture Following Liver Transplantation: A Reasonable Option

Hepatic Artery Ligation for Arterial Rupture Following Liver Transplantation: A Reasonable Option

Hemobilia

Use of Preserved Vascular Homografts in Liver Transplantation: Hepatic Artery Aneurysms and Other Complications

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