Two cases of small bowel necrosis during liver transplantation / 中国组织工程研究

ABSTRACT

BACKGROUND:The incidence of intestinal necrosis during liver transplantation is low, and most of them abandon transplantation and thus leading to death. OBJECTIVE:To retrospectively analyze the reasons which result in smal intestinal necrosis during liver transplantation, and to explore the viable treatment options. METHODS:The clinical data of 207 patients were reviewed, two patients complicated with smal intestinal necrosis during liver transplantation. Case 1 underwent liver transplantation combined with necrotic smal bowel resection. Case 2 abandoned liver transplantation, and received conservative treatment. RESULTS AND CONCLUSION:Both of the two patients had preoperative portal system thrombosis. In Case 1, there was upper gastrointestinal bleeding before transplantation, and repeated application of hemostatic drugs could increase the thrombosis and thus resulting smal intestinal necrosis. At 10 days after liver transplantation, the patients complicated with intestinal fistula and were treated with fistulation. After fistulation, the patient suffered from abdominal cavity and lung infections. At 7 days after anti-infection treatment and immunosuppressant stopped, the infections were cured. At 40 days after fistulation, the intestinal fistula was healed and the patient was discharged after rehabilitation. After fol owed-up for 2 years, the patient was stil healthy living. The Case 2 suffered with mass ascites which lead to abdominal compartment syndrome, the intestinal venous disorders lead to extensive smal bowel necrosis. At 2 days after abandon the liver transplantation, the patient was dead because of multiple organ failure. The patients who waiting for liver transplantation had preoperative portal system thrombosis, abdominal pain and abdominal distention, should be pay attention to intestinal necrosis. Patients with smal bowel necrosis during liver transplantation can be cured with liver transplantation combined with necrotic smal bowel resection.