Portal vein reconstruction using bovine pericardium graft after traumatic injury in a 6-year-old male: A case report

Abstract

Introduction

Traumatic portal vein injury (PVI) is a rare but life-threatening condition with a high mortality rate. Despite advancements in surgical techniques, the management of complex portal vein injuries remains challenging.

Case presentation

A 6-year-old male presented with abdominal trauma after being hit by a motor rickshaw. Despite inconclusive initial diagnostic imaging including a bedside abdominal ultrasound showing minimal ascites, the deterioration of all clinical parameters prompted an exploratory laparotomy. Intra-operative exploration revealed a transected portal vein with significant tissue loss and an avulsed common bile duct. Portal vein reconstruction was done using commercially available bovine pericardium, which was tubularized and grafted proximally and distally with polypropylene 6–0. Intra-operative Doppler ultrasound confirmed the successful restoration of portal venous flow. Additionally, we closed the common bile duct and did a cholecysto-duodenostomy to restore bile flow. Postoperative anticoagulation therapy included unfractionated heparin (10U/kg/hour) for 72 hours followed by aspirin (75mg daily) for six months, frequently monitoring the patency of the graft by Doppler ultrasound. He had a brief cardiac arrest 3 days after the operation due to ventilator-associated complications and suffered an ischemic brain injury that led to sensorimotor deficits. After an initial recovery in the intensive care unit, he was transferred to a rehabilitation unit and was discharged on postoperative day 19. At six-month of follow-up, Doppler ultrasound have confirmed graft patency. Liver function tests remain normal.

Conclusion

Bovine pericardium grafts appear to be a valuable option for the management of complex portal vein injuries.