Management of subcapsular hematoma of the graft after living donor liver transplantation

Role of Contrast-Enhanced Ultrasound in the Detection of Complications After Ultrasound-Guided Liver Interventional Procedures

The role of contrast-enhanced ultrasound (CEUS) in interventional ultrasound-guided procedures in the liver has been increasingly recognized. However, little is known about the capability of CEUS for diagnosing complications after liver biopsy and ablation with special regard to postprocedural hemorrhage. The aim of this Pictorial Essay is to present the CEUS features of a wide spectrum of vascular complications (with or without bleeding) and injuries of the surrounding abdominal and chest wall occurring after liver interventional procedures.

Subcapsular hematoma resulting in hepatic ischemia as a complication of necrotizing pancreatitis

This report presents a case of necrotizing pancreatitis resulting in a large hepatic subcapsular hematoma that led to development of hepatic ischemia and early stages of liver failure. Following surgical decompression, liver function dramatically improved, but large areas of peripheral hepatic infarction had developed. This case demonstrates the risks of a rapidly expanding hepatic subcapsular hematoma, emphasizes the importance of recognizing and aggressively treating active bleeding, and cautions against administering anticoagulation and tissue-plasminogen activator in this clinical scenario.

Safety and efficacy of transhepatic and transsplenic access for endovascular management of portal vein complications after liver transplantation

The purpose of this article is to evaluate and compare the safety and efficacy of endovascular management of the portal vein (PV) via percutaneous transsplenic access versus percutaneous transhepatic access in liver transplantation (LT) recipients. A total of 18 patients who underwent endovascular management of PV via percutaneous transhepatic (n = 8) and transsplenic (n = 10) access were enrolled. Transsplenic access was chosen if the spleen was located in a normal position, the splenic vein (SpV) was preserved, and the target lesion did not involve confluence of the superior mesenteric and SpVs. Accessibility of the percutaneous transsplenic puncture was confirmed via ultrasound (US) in the angiography suite. All procedures were performed under local anesthesia. Percutaneous transhepatic or transsplenic access was performed using a 21-gauge Chiba needle under US and fluoroscopic guidance, followed by balloon angioplasty, stent placement, or variceal embolization. The access tract was embolized using coils and a mixture (1:2) of glue and ethiodized oil. Transhepatic or transsplenic access was successfully achieved in all patients. A total of 12 patients underwent stent placement; 3 had balloon angioplasty only; 2 had variceal embolization only; and 1 had variceal embolization followed by successful stent placement. Regarding major complications, 1 patient experienced a SpV tear with extravasation during transsplenic balloon angioplasty, which was successfully managed using temporary balloon inflation, followed by transfusion. Clinical success was achieved in 9 of 11 (82%) patients who exhibited clinical manifestations. The remaining 7 patients who underwent prophylactic endovascular management were healthy. In conclusion, endovascular management of PV via percutaneous transsplenic access is a relatively safe and effective alternative that does not damage the liver grafts of LT recipients. Liver Transplantation 23 1133-1142 2017 AASLD.

Hepatic capsular avulsion after video-assisted thoracic biopsy of the lung

We report a life-threatening subcapsular hepatic hemorrhage after VATS, successfully treated with Gelfoam embolization of the right hepatic artery. The postprocedure course was complicated by infarction of the right hepatic lobe.

Uncommon causes of hepatic congestion in patients after living donor liver transplantation

OBJECTIVE

The purpose of this article is to illustrate the radiologic findings of various uncommon conditions that cause hepatic congestion in patients after living donor liver transplantation.

CONCLUSION

Radiologic findings of hepatic congestion may vary according to the cause and the level of outflow obstruction. It is important for radiologists to be aware of such variations in order to make an early diagnosis of hepatic congestion and to enable timely proper management in recipients after living donor liver transplantation.

[Subcapsular hematoma and rupture of the liver graft]

Subcapsular hematoma and/or rupture of the graft is uncommon but serious complication of liver transplantation. It may develop spontaneously or following parenchymal injuries or percutaneous transhepatic invasive procedures. This report describes three cases of subcapsular hematoma and/or rupture of the graft with different courses among 350 liver transplantations. In the first case, the patient died due to graft rupture caused by a pseudoaneurysm after biopsy. In the second case, a small injury of the donor liver resulted in a deep rupture, which required partial resection of the graft. The patient died in sepsis later. The third patient presented with a large subcapsular haematoma during transplantation, which was successfully treated. The authors' strategies developed intraoperatively for the management of hematomas. These involve opening and removing of the haematoma, haemostasis with Argon coagulation, which resulted in an adherent Glisson's capsule to the parenchyma and covering with collagen fleece coated with fibrinogen and thrombin.

Early postoperative bleeding after living donor liver transplantation

We discuss the clinical impacts of early postoperative bleedings after LDLT and CT findings or CT angiographic findings compared with angiography according to the various bleeding causes. Sudden development of hematoma as well as extravasation of contrast material on CT scan are thought to be predictive CT findings of early postoperative bleeding in post-hepatic transplant patients. Careful consideration for these findings can prevent the progression into a catastrophic status that requires surgical management.