Massive Subcutaneous Emphysema, Pneumoperitoneum, Pneumoretroperitoneum, and Pneumoscrotum following Endoscopic Retrograde Cholangiopancreatography in a Living Liver Donor.

IF 0.3 Q4 TRANSPLANTATION International Journal of Organ Transplantation Medicine Pub Date : 2018-01-01 Epub Date: 2018-08-01
S Akbulut, B Isik, Y Karipkiz, S Yilmaz
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Abstract

Despite having many advantages, living donor liver transplantation has not been adopted by western countries due to risk of nearly life-threatening complications after living donor hepatectomy (LDH). Herein, we aimed at presenting the management of a 19-year-old patient who suffered life-threatening complications after right lobe LDH. A multiple detector computed tomography (MDCT) revealed a bilioma at the cut surface of the remnant liver, for which a transhepatic drainage catheter was placed. Endoscopic retrograde cholangiopancreatography (ERCP) performed to decompress biliary tract, but the biliary tract could not be cannulized due to post-precut bleeding. On the next day, extensive crepitation was detected and MDCT showed subcutaneous emphysema, pneumoperitoneum, pneumoretroperitoneum, and pneumoscrotum (ERCP-related duodenal perforation?). However, the patient showed significant deterioration of physical examination findings, fever, and infectious parameters, and therefore was taken to the operating room. Kocher maneuver revealed no apparent duodenal perforation. Then, a 2-mm bile duct was found open at the caudate lobe, through which bile leaked. Then, common bile duct exploration and T-tube placement were performed, followed by suture closure of the bile orifice at the caudate lobe. Massive air previously identified completely disappeared one week after the operation.

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活体肝供者经内窥镜逆行胰胆管造影后发现大量皮下肺气肿、气腹、腹膜后气肿及阴囊。
尽管活体肝移植有许多优点,但由于活体肝切除术(LDH)后几乎危及生命的并发症的风险,活体肝移植尚未被西方国家采用。在此,我们的目的是介绍一位19岁的患者在右肺LDH后遭受危及生命的并发症的处理。多检测器计算机断层扫描(MDCT)显示在残肝切面有胆囊瘤,为此放置了经肝引流管。行内镜逆行胆管造影(ERCP)对胆道进行减压,但由于术前出血,胆道无法插管。次日,大范围咯气,MDCT示皮下肺气肿、气腹、腹膜后气肿、阴囊气肿(ercp相关十二指肠穿孔)。然而,患者的体格检查结果、发热和感染参数明显恶化,因此被送往手术室。Kocher手法未见明显十二指肠穿孔。然后,在尾状叶发现一个2mm的胆管打开,胆汁通过该胆管流出。然后探查胆总管,放置t管,缝合尾状叶胆管口。此前确认的大量空气在行动一周后完全消失。
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来源期刊
CiteScore
1.60
自引率
0.00%
发文量
0
审稿时长
12 weeks
期刊介绍: The International Journal of Organ Transplantation Medicine (IJOTM) is a quarterly peer-reviewed English-language journal that publishes high-quality basic sciences and clinical research on transplantation. The scope of the journal includes organ and tissue donation, procurement and preservation; surgical techniques, innovations, and novelties in all aspects of transplantation; genomics and immunobiology; immunosuppressive drugs and pharmacology relevant to transplantation; graft survival and prevention of graft dysfunction and failure; clinical trials and population analyses in the field of transplantation; transplant complications; cell and tissue transplantation; infection; post-transplant malignancies; sociological and ethical issues and xenotransplantation.
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