ABSTRACT
Portal hypertension may develop as a result of hepatic cirrhosis. One of the serious complications of portal hypertension is variceal hemorrhage. In recipients with esophageal varices, despite refinements in surgical techniques, variceal bleeding can occur during liver transplantation. The vascular isolation during cross-clamped inferior vena cava, hepatic and portal veins is associated with increases of inferior vena caval and portal venous pressures. We experienced three cases of bleeding from esophageal varices before and during living related liver transplantation and considered their management. One is bleeding during cross-clamped inferior vena cava, hepatic and portal veins. The others were carried out intraoperative endoscopy and endoscopic variceal ligation because of high risk of the esophageal variceal rupture. They were all managed successfully and recovered uneventfully. The anesthesiologists must keep in mind of the possibility of esophageal variceal bleeding during liver transplantation, and if that happens, prompt diagnosis and management must be taken.
Subject(s)
Anesthesia , Endoscopy , Esophageal and Gastric Varices , Hemorrhage , Hypertension, Portal , Ligation , Liver , Liver Cirrhosis , Liver Transplantation , Portal Vein , Rupture , Vena Cava, Inferior , Venous PressureABSTRACT
Objective To evaluate the efficacy and complication of endoscopic dense ligation for bleeding esophageal varices(EV). Methods 128 cases of EV experienced varcies ligation, and 16～22 points(average 18.8 points) of the varices were ligated by using dense ligation, while only 5～6 points were ligated in common ligation (common method) for varices. All patients got one to two times of ligation therapy. Results In dense ligation group, the rate of prompt hemostasis was 96.9%, rate of elimination of EV was 92.2% with one therapy, and 96.9% with twice therapy, while the rate of bleeding was 0.8%. In common method the rates were 95.7%, 42.6%, 64.7% and 7.1% respectively. Between the two groups, the rate of elimination of EV and rebleeding had significant difference (P