Internal hernia of the small bowel around infrarenal arterial conduits after liver transplantation

Abstract

Internal hernia of the small bowel around infrarenal arterial conduits after liver Internal hernia of the small bowel is an uncommon but fatal complication of liver transplantation. The placement of infrarenal arterial conduits for arterial revascularization is an important technique for arterial reconstruction after liver transplantation. We report three cases of internal hernia with volvulus of the small bowel caused by the use of infrarenal arterial conduits. We reviewed the records of 1066 consecutive patients who underwent orthotopic liver transplantation between June 1994 and April 2000 at the University of Miami. In 271 of these patients, grafts were revascularized by anastomosing the donor iliac artery to the infrarenal aorta (an infrarenal arterial conduit). Two patients died after the surgery. One patient died of multiple organ failure because of sepsis 1 month after the surgery that involved reduction of the internal hernia and biliary reconstruction. Another patient died of multiple organ failure because of sepsis 8 days after the surgery that involved reduction of the internal hernia and adhesiolysis. One patient survived after the surgery that involved thrombectomy of the arterial graft and reduction of the internal hernia. Although there was ischemic damage to the liver after the surgery, the patient recovered. However, he died of liver failure because of recurrent infection with the hepatitis C virus 18 months after the surgery. Transplant surgeons should be aware that this complication causes not only bowel obstruction but also hepatic arterial thrombosis and ischemic liver damage. In order to prevent this complication, the arterial conduit should be retroperitonealized at the time of transplantation.

Right-sided diaphragmatic hernia in infants after liver transplantation

“…Most complications are of the infectious type, and internal hernia of the small intestine with or without volvulus is uncommon; according to the few available reports, it has been caused by herniation around the Roux-en-Y loop (or its mesentery) [9,13] or through an inguinal or an incisional hernia [13] in most cases, and around a vascular conduit in a single case [14].…”

Long-term deleterious effects of aortohepatic conduits in primary liver transplantation: Proceed with caution

“…The clothoid curve (also known as the Euler or Cornu spiral), used in railway, highway, and roller coaster designs, is inspiring because it produces an ideal shape for a transition (or easement) curve connecting a straight section with a section of a given curvature . Retroperitonealization of the aortohepatic conduit is recommended for preventing an internal hernia . Recently, the phenomenon of the neovascularized liver was investigated in detail, and late HAT and Roux‐en‐Y anastomosis were associated with its occurrence .…”

Post-transplant lymphoproliferative disorder presented as small bowel intussusception in adult liver transplant patient

“…Blachar and Federle [2] reported a 1.2% incidence of intestinal obstruction in 4,001 liver transplantations performed during a 15-year period. Unusual causes such as internal hernias around the infrarenal arterial conduits or through the mesenteric defect for Roux-en-Y hepaticojejunostomy, diaphragmatic hernias, and intussusceptions are reported [3-5]. In pediatric liver transplant patients, there are a few reports describing intussusception associated with PTLD, but these are extremely rare in adult patients to the best of our knowledge.…”