Cargando…

Liver transplantation following hepatic artery avulsion in a trauma patient

BACKGROUND: Hepatic artery avulsion following politrauma is an extremely rare condition with a very high mortality rate. Management is based on damage control surgery given the precarious situation of these patients. Ligating the artery is one option under such circumstances, despite potential conse...

Descripción completa

Detalles Bibliográficos
Autores principales: Fernández Cepedal, Lara, Gastaca Mateo, Mikel, Prieto Calvo, Mikel, Valdivieso López, Andrés, Fernández Gómez Cruzado, Laura, Perez González, Christian, Perfecto Valero, Arkaitz, Colina Alonso, Alberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451184/
https://www.ncbi.nlm.nih.gov/pubmed/30976384
http://dx.doi.org/10.1093/jscr/rjz063
_version_ 1783409145088573440
author Fernández Cepedal, Lara
Gastaca Mateo, Mikel
Prieto Calvo, Mikel
Valdivieso López, Andrés
Fernández Gómez Cruzado, Laura
Perez González, Christian
Perfecto Valero, Arkaitz
Colina Alonso, Alberto
author_facet Fernández Cepedal, Lara
Gastaca Mateo, Mikel
Prieto Calvo, Mikel
Valdivieso López, Andrés
Fernández Gómez Cruzado, Laura
Perez González, Christian
Perfecto Valero, Arkaitz
Colina Alonso, Alberto
author_sort Fernández Cepedal, Lara
collection PubMed
description BACKGROUND: Hepatic artery avulsion following politrauma is an extremely rare condition with a very high mortality rate. Management is based on damage control surgery given the precarious situation of these patients. Ligating the artery is one option under such circumstances, despite potential consequences including ischemic cholangiopathy (IC). Ischemic cholangiopathy, which can be caused by an insufficient blood supply to the bile duct, generally results in stricture and recurrent cholangitis, and the need for a liver transplant in extreme cases. CASE PRESENTATION: We present the case of a 37-year-old male with multiple traumas after falling from the third floor of a building. He was hemodynamically unstable upon arrival at the emergencies department, with no improvement on administration of aggressive fluid therapy. A Echo-FAST exam evidenced fluid in all quadrants, so the patient was transferred to the operating room where a 4-litre hemoperitoneum secondary to total avulsion of the proper hepatic artery was observed. The patient required massive transfusion and vasoactive drugs, with instability throughout the intervention; therefore, we decided to ligate the proper hepatic artery. Hepatic dysfunction and diffuse IC with multiple episodes of recurrent cholangitis were observed during the postoperative period. Given the irreversible clinical picture, we opted for a liver transplant 70 days after the patient’s initial admission. The patient died on Day 34 post-transplant due to irreversible ischemic brain damage and a right occipital hemorrhage. CONCLUSIONS: Hepatic artery avulsion due to trauma is very rare and its management very complex, and in certain situations the artery must be ligated. The main consequence of ligating the hepatic artery is IC, which is more frequently observed secondary to iatrogenic lesions or systemic diseases, while very few cases have been published in which IC is secondary to hepatic artery avulsion caused by hepatic trauma. Treatment depends on the extent of ischemia, and when the damage is diffuse, as in our case, it may involve a liver transplant.
format Online
Article
Text
id pubmed-6451184
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-64511842019-04-11 Liver transplantation following hepatic artery avulsion in a trauma patient Fernández Cepedal, Lara Gastaca Mateo, Mikel Prieto Calvo, Mikel Valdivieso López, Andrés Fernández Gómez Cruzado, Laura Perez González, Christian Perfecto Valero, Arkaitz Colina Alonso, Alberto J Surg Case Rep Case Report BACKGROUND: Hepatic artery avulsion following politrauma is an extremely rare condition with a very high mortality rate. Management is based on damage control surgery given the precarious situation of these patients. Ligating the artery is one option under such circumstances, despite potential consequences including ischemic cholangiopathy (IC). Ischemic cholangiopathy, which can be caused by an insufficient blood supply to the bile duct, generally results in stricture and recurrent cholangitis, and the need for a liver transplant in extreme cases. CASE PRESENTATION: We present the case of a 37-year-old male with multiple traumas after falling from the third floor of a building. He was hemodynamically unstable upon arrival at the emergencies department, with no improvement on administration of aggressive fluid therapy. A Echo-FAST exam evidenced fluid in all quadrants, so the patient was transferred to the operating room where a 4-litre hemoperitoneum secondary to total avulsion of the proper hepatic artery was observed. The patient required massive transfusion and vasoactive drugs, with instability throughout the intervention; therefore, we decided to ligate the proper hepatic artery. Hepatic dysfunction and diffuse IC with multiple episodes of recurrent cholangitis were observed during the postoperative period. Given the irreversible clinical picture, we opted for a liver transplant 70 days after the patient’s initial admission. The patient died on Day 34 post-transplant due to irreversible ischemic brain damage and a right occipital hemorrhage. CONCLUSIONS: Hepatic artery avulsion due to trauma is very rare and its management very complex, and in certain situations the artery must be ligated. The main consequence of ligating the hepatic artery is IC, which is more frequently observed secondary to iatrogenic lesions or systemic diseases, while very few cases have been published in which IC is secondary to hepatic artery avulsion caused by hepatic trauma. Treatment depends on the extent of ischemia, and when the damage is diffuse, as in our case, it may involve a liver transplant. Oxford University Press 2019-04-06 /pmc/articles/PMC6451184/ /pubmed/30976384 http://dx.doi.org/10.1093/jscr/rjz063 Text en Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2019. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Report
Fernández Cepedal, Lara
Gastaca Mateo, Mikel
Prieto Calvo, Mikel
Valdivieso López, Andrés
Fernández Gómez Cruzado, Laura
Perez González, Christian
Perfecto Valero, Arkaitz
Colina Alonso, Alberto
Liver transplantation following hepatic artery avulsion in a trauma patient
title Liver transplantation following hepatic artery avulsion in a trauma patient
title_full Liver transplantation following hepatic artery avulsion in a trauma patient
title_fullStr Liver transplantation following hepatic artery avulsion in a trauma patient
title_full_unstemmed Liver transplantation following hepatic artery avulsion in a trauma patient
title_short Liver transplantation following hepatic artery avulsion in a trauma patient
title_sort liver transplantation following hepatic artery avulsion in a trauma patient
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451184/
https://www.ncbi.nlm.nih.gov/pubmed/30976384
http://dx.doi.org/10.1093/jscr/rjz063
work_keys_str_mv AT fernandezcepedallara livertransplantationfollowinghepaticarteryavulsioninatraumapatient
AT gastacamateomikel livertransplantationfollowinghepaticarteryavulsioninatraumapatient
AT prietocalvomikel livertransplantationfollowinghepaticarteryavulsioninatraumapatient
AT valdiviesolopezandres livertransplantationfollowinghepaticarteryavulsioninatraumapatient
AT fernandezgomezcruzadolaura livertransplantationfollowinghepaticarteryavulsioninatraumapatient
AT perezgonzalezchristian livertransplantationfollowinghepaticarteryavulsioninatraumapatient
AT perfectovaleroarkaitz livertransplantationfollowinghepaticarteryavulsioninatraumapatient
AT colinaalonsoalberto livertransplantationfollowinghepaticarteryavulsioninatraumapatient