Veno‐Atrial Bypass for the Operative Treatment of Septic Gas Gangrene Secondary to Delayed Hepatic Artery Thrombosis

Veno‐Atrial Bypass for the Operative Treatment of Septic Gas Gangrene Secondary to Delayed Hepatic Artery Thrombosis

The occurrence of late hepatic artery thrombosis after orthotopic liver transplantation can result in gas gangrene of the graft. This clinical scenario has the potential to be rapidly fatal as a result of fulminant hepatic failure, sepsis and multiple‐organ‐failure syndrome. Emergency operative inte...

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Bibliographic Details
Published in:American journal of transplantation Vol. 3; no. 6; pp. 760 - 763
Main Authors: Chan, Gabriel, Tchervenkov, Jean, Cantarovich, Marcelo, Alpert, Eliot, Deschenes, Marc, Ergina, Patrick, Metrakos, Peter, Barkun, Jeffrey
Format: Journal Article
Language:English
Published: Oxford, UK Munksgaard International Publishers 01-06-2003
Subjects:
Adult
Anastomosis, Surgical
Extra corporeal bypass
fulminant hepatic failure
gangrene hepatic artery thrombosis
Gas Gangrene - etiology
Gas Gangrene - surgery
hepatectomy
Hepatic Artery - pathology
Hepatic Artery - surgery
Humans
liver transplantation
Liver Transplantation - adverse effects
Male
Middle Aged
sepsis
Thrombosis - complications
Thrombosis - surgery
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Summary:The occurrence of late hepatic artery thrombosis after orthotopic liver transplantation can result in gas gangrene of the graft. This clinical scenario has the potential to be rapidly fatal as a result of fulminant hepatic failure, sepsis and multiple‐organ‐failure syndrome. Emergency operative intervention is indicated to remove the septic source and replace the failed liver. In this report, both cases demonstrated rapid deterioration within 24 h from the onset of symptoms, in spite of maximum supportive care. Intra‐operative handling of the gangrenous graft resulted in hemodynamic instability and a technically unfeasible hepatectomy. The use of extra‐corporeal veno‐atrial bypass, by isolating the septic source, allowed for graft hepatectomy and successful re‐transplantation in the second of these reported cases.
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ISSN:1600-6135
1600-6143
DOI:10.1034/j.1600-6143.2003.00129.x