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Orozco G, Gupta M, Ancheta A, Shah MB, Warriner Z, Marti F, Mei X, Desai S, Bernard A, Gedaly R. Liver transplantation for severe hepatic trauma: A multicenter analysis from the UNOS data set. J Trauma Acute Care Surg 2024; 96:763-768. [PMID: 37994467 DOI: 10.1097/ta.0000000000004220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND Orthotopic liver transplantation (OLT) is rarely indicated after hepatic trauma but it can be the only therapeutic option in some patients. There are scarce data analyzing the surgical outcomes of OLT after trauma. METHODS We used the UNOS data set to identify patients who underwent OLT for trauma from 1987 to 2022 and compared them to a cohort of patients transplanted for other indications. Cox proportional hazard and multivariable logistic regression analyses were performed to assess predictors of graft and patient survival. RESULTS Seventy-two patients underwent OLT for trauma during the study period. Patients with trauma were more frequently on mechanical ventilation at the time of transplantation (26.4% vs. 7.6%, p < 0.001) and had a greater incidence of pretransplant portal vein thrombosis (12.5% vs. 4%, p = 0.002). Our 4:1 matched analysis showed that trauma patients had significantly shorter wait times, higher incidence of pretransplant portal vein thrombosis and prolonged length of stay. Trauma was associated with decreased overall graft survival (hazards ratio, 1.42; 95% confidence interval, 1.01-1.98), and increased length of stay ( p = 0.048). There were no significant differences in long-term patient survival. CONCLUSION Unique physiological and vascular challenges after severe hepatic trauma might be associated with decreased graft survival in patients requiring liver transplantation. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Gabriel Orozco
- From the Division of Transplantation, Department of Surgery (G.O., M.G., A.A., M.B.S., F.M., X.M., S.D., R.G.), and Division of Acute Care Surgery, Trauma & Surgical Critical Care, Department of Surgery (Z.W., A.B.), University of Kentucky, Lexington, Kentucky
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2
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Perez MC, Kim SC, Egunsola A, Reitz A, Archer-Arroyo K, Smith RN, Williams KN, Udobi K, Sola R, Dente CJ, Cristescu MM, Grant A, Nguyen J. Bleeding From a Hepatic Artery-Portal Vein Fistula After Repair of a Stab Wound to the Liver. Am Surg 2023; 89:2089-2091. [PMID: 34171964 DOI: 10.1177/00031348211029847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew C Perez
- Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Steven C Kim
- Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Adekemi Egunsola
- Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Alexandra Reitz
- Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Krystal Archer-Arroyo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Randi N Smith
- Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Keneeshia N Williams
- Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Kahdi Udobi
- Department of Surgery, Morehouse School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Richard Sola
- Department of Surgery, Morehouse School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Christopher J Dente
- Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Mircea M Cristescu
- Department of Vascular and Interventional Radiology, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - April Grant
- Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Jonathan Nguyen
- Department of Surgery, Morehouse School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
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Herrero A, Souche R, Panaro F, Navarro F. Endovascular balloon occlusion during reconstruction of portal vein injury. Langenbecks Arch Surg 2020; 405:391-395. [PMID: 32361778 DOI: 10.1007/s00423-020-01886-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/22/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Repair of portal vein injury in a hostile abdomen can be very challenging, complicated by massive hemorrhage or stenosis. It can seldom be successfully carried out, even by experienced hepatobiliary surgeons. The ideal venous clamping technique is often not feasible and increases the risk of lethal portal vein laceration. The common mistake being the forceful use of clamps around the vein in the attempt to obtain vascular control, resulting in additional injuries. METHODS We provide a descriptive report of two cases detailing a careful step-by-step technique for the management of portal vein injury by inserting an endovascular balloon inflated with serum to control bleeding and repair the vein. RESULTS In patients who required this technique, no bleeding recurrence, nor portal vein thrombosis or stenosis was detected by CT-scan during follow-up. CONCLUSION The endovascular balloon occlusion technique for the reconstruction of portal vein injuries in hostile abdomen is a safe and life-saving procedure that should be part of the armamentarium of visceral surgeons.
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Affiliation(s)
- Astrid Herrero
- Department of Digestive Surgery and Transplantation, Montpellier University Hospital, University of Montpellier-Nîmes, 641 avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Regis Souche
- Department of Digestive Surgery and Transplantation, Montpellier University Hospital, University of Montpellier-Nîmes, 641 avenue du Doyen Gaston Giraud, 34090, Montpellier, France.
- Department of Digestive Surgery and Transplantation, Saint Eloi Hospital, 80 avenue Augustin Fliche, 34295, Montpellier, France.
| | - Fabrizio Panaro
- Department of Digestive Surgery and Transplantation, Montpellier University Hospital, University of Montpellier-Nîmes, 641 avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Francis Navarro
- Department of Digestive Surgery and Transplantation, Montpellier University Hospital, University of Montpellier-Nîmes, 641 avenue du Doyen Gaston Giraud, 34090, Montpellier, France
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Wang VY, Wang VL, Kao L, Elwood DR. A Complex Game of Go Fish: A Hybrid Endoscopic and Surgical Approach to a Fish Bone Perforation of the Portal Vein. Am Surg 2020; 86:e153-e155. [PMID: 32223827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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5
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Grzeskowiak RM, Barrett EJ, Rodgerson DH. Cecal entrapment within the epiploic foramen in a mare. Can Vet J 2017; 58:842-844. [PMID: 28761191 PMCID: PMC5508968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An 11-year-old Thoroughbred mare with colic unresponsive to medical treatment underwent exploratory laparotomy. During surgery the cecum was found entrapped within the epiploic foramen from left to right. The entrapped cecum was reduced through the foramen by gentle traction. After reduction of the cecum, rupture of the portal vein was detected. Loss of a large amount of blood prompted euthanasia during surgery.
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Ferrada P, Ratnasekera A, Khokar A. Penetrating Traumatic Laceration of Common Hepatic Artery and Portal Vein: A Rare Story of Success. Am Surg 2017; 83:e148-e150. [PMID: 28541837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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7
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Wakamatsu T, Ogasawara S, Chiba T, Yokoyama M, Inoue M, Kanogawa N, Saito T, Suzuki E, Ooka Y, Tawada A, Yokosuka O. Impact of Radiofrequency Ablation-Induced Glisson's Capsule-Associated Complications in Patients with Hepatocellular Carcinoma. PLoS One 2017; 12:e0170153. [PMID: 28099460 PMCID: PMC5242538 DOI: 10.1371/journal.pone.0170153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/29/2016] [Indexed: 01/16/2023] Open
Abstract
Background Radiofrequency ablation (RFA) is commonly used to locally treat hepatocellular carcinoma (HCC). However, when tumors are close to the Glisson’s capsule, RFA may induce injury in this region, complicating therapeutic efforts. We investigated the impact of RFA-induced Glisson’s capsule-associated complications on liver function and prognosis of HCC patients. Methods We retrospectively reviewed our patient database and found 170 early-stage HCC patients treated via RFA from April 2004 to December 2012. We defined RFA-induced Glisson’s capsule-associated complication as lasting hepatic arterioportal (AP) fistula, major intrahepatic bile-duct dilatation (affecting two or more subsegments), or hepatic infarction. We also defined liver failure as initial occurrence of either total bilirubin increase (>3.0 mg/dL), uncontrolled ascites, or encephalopathy. Results In our cohort, 15 patients had RFA-induced Glisson’s capsule-associated complications (incidence of related complications, with some overlap: lasting AP fistula, n = 9; major intrahepatic bile-duct dilatation, n = 7; and hepatic infarction, n = 2). The cumulative incidence of liver failure before stage progression was significantly higher and the median overall survival (OS) was significantly lower (52.3 months) in HCC patients with Glisson’s capsule-associated complications than in those without Glisson’s capsule-associated complications (95.0 months). In addition, multivariate analysis demonstrated that Glisson’s capsule-associated complication was a significant independent factor associated with OS. Conclusions In this study, we have shown that early-stage HCC patients with RFA-induced Glisson’s capsule-associated complications may have higher risks in poor prognosis.
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Affiliation(s)
- Toru Wakamatsu
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
- * E-mail:
| | - Masayuki Yokoyama
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masanori Inoue
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kanogawa
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoko Saito
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Eiichiro Suzuki
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshihiko Ooka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Akinobu Tawada
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Osamu Yokosuka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Abstract
Traumatic injuries to the portal vein (PV) and superior mesenteric vein (SMV) are rare and carry a high mortality rate, and the best approach and method of repair is still subject to debate. The objective of the present study was to analyze risk factors for mortality in portal and superior mesenteric venous injuries. A retrospective analysis of 18 patients during a 5-year period was performed. Mechanism of injury, shock upon admission, Revised Trauma Score (RTS), Injury Severity Score (ISS), intraoperative fluid requirements, classification of venous injury severity, and associated injuries were analyzed as potential predictors of outcome. All patients were male, 9 were victims of gunshot wounds, and 11 were in shock at the time of admission. Eight patients sustained PV, and 12 sustained SMV injuries. The great majority of patients had more than 1 associated injury and 61% had an associated vascular injury. Mortality rate correlated with injury severity. Overall mortality rate was 72%. Nonsurvivors had higher ISS than survivors (24 ±0.4 and 20 ±1.7, respectively; p= 0.006). Uncontrollable intraoperative hemorrhage was the cause of death in 5 of 13 patients (38.4%). Six patients died during the postoperative period from complications of prolonged shock and multiple organ failure, and 2 died of sepsis. The physiologic status upon admission, the number of associated injuries, and the severity of the vascular injury are the most important factors related to mortality in PV and SMV injuries.
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Affiliation(s)
- Raul Coimbra
- University of California San Diego School of Medicine, CA, USA.
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Gao L, Chen X, Peng T, Yang D, Wang Q, Lv Z, Shen J. Caveolin-1 protects against hepatic ischemia/reperfusion injury through ameliorating peroxynitrite-mediated cell death. Free Radic Biol Med 2016; 95:209-15. [PMID: 27021966 DOI: 10.1016/j.freeradbiomed.2016.03.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 12/24/2022]
Abstract
Nitrative stress is considered as an important pathological process of hepatic ischemia and reperfusion injury but its regulating mechanisms are largely unknown. In this study, we tested the hypothesis that caveolin-1 (Cav-1), a plasma membrane scaffolding protein, could be an important cellular signaling against hepatic I/R injury through inhibiting peroxynitrite (ONOO(-))-induced cellular damage. Male wild-type mice and Cav-1 knockout (Cav-1(-/-)) were subjected to 1h hepatic ischemia following 1, 6 and 12h of reperfusion by clipping and releasing portal vessels respectively. Immortalized human hepatocyte cell line (L02) was subjected to 1h hypoxia and 6h reoxygenation and treated with Cav-1 scaffolding domain peptide. The major discoveries included: (1) the expression of Cav-1 in serum and liver tissues of wild-type mice was time-dependently elevated during hepatic ischemia-reperfusion injury. (2) Cav-1 scaffolding domain peptide treatment inhibited cleaved caspase-3 expression in the hypoxia-reoxygenated L02 cells; (3) Cav-1 knockout (Cav-1(-/-)) mice had significantly higher levels of serum transaminases (ALT&AST) and TNF-α, and higher rates of apoptotic cell death in liver tissues than wild-type mice after subjected to 1h hepatic ischemia and 6hour reperfusion; (4) Cav-1(-/-) mice revealed higher expression levels of iNOS, ONOO(-) and 3-nitrotyrosine (3-NT) in the liver than wild-type mice, and Fe-TMPyP, a representative peroxynitrite decomposition catalyst (PDC), remarkably reduced level of ONOO(-) and 3-NT and ameliorated the serum ALT, AST and TNF-α levels in both wild-type and Cav-1(-/-) mice. Taken together, we conclude that Cav-1 could play a critical role in preventing nitrative stress-induced liver damage during hepatic ischemia-reperfusion injury.
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Affiliation(s)
- Lei Gao
- School of Chinese Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, China; School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Xingmiao Chen
- School of Chinese Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, China; Research Centre of Heart, Brain, Hormone & Healthy Aging, the University of Hong Kong, Hong Kong, China
| | - Tao Peng
- Morningside Laboratory for Chemical Biology and Department of Chemistry, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - Dan Yang
- Morningside Laboratory for Chemical Biology and Department of Chemistry, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - Qi Wang
- Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhiping Lv
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China.
| | - Jiangang Shen
- School of Chinese Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, China; Research Centre of Heart, Brain, Hormone & Healthy Aging, the University of Hong Kong, Hong Kong, China; Institute of Clinical Pharmacology, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
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Testerman GM, Pham HD. Repair of isolated hepatic artery injury from a samurai sword. Am Surg 2015; 81:E236-E237. [PMID: 26031250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- George M Testerman
- Holston Valley Hospital Level 1 Trauma Center, ETSU Department of Surgery, Kingsport, Tennessee, USA
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Jadrijevic S, Sef D, Kocman B, Mrzljak A, Matasic H, Skegro D. Right hepatectomy due to portal vein thrombosis in vasculobiliary injury following laparoscopic cholecystectomy: a case report. J Med Case Rep 2014; 8:412. [PMID: 25481385 PMCID: PMC4295332 DOI: 10.1186/1752-1947-8-412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 09/16/2014] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Vasculobiliary injury composed of bile duct, portal vein and hepatic artery injury is a rare, but the most severe, complication after cholecystectomy that may require hepatectomy or even urgent liver transplantation. CASE PRESENTATION We present a case of a 36-year-old Caucasian woman with a biliary sepsis and a large right liver lobe abscess due to an extreme vasculobiliary injury after laparoscopic cholecystectomy. Bismuth type IV biliary duct injury, portal vein thrombosis and injury of right hepatic artery were identified, resulting in life-threatening septic episodes. Right hepatectomy with Roux-en-Y hepaticojejunostomy and reconstruction of her portal vein with a vein allograft were performed. She fully recovered and remained well during 3 years of follow-up. CONCLUSIONS Although rare, the impact of vasculobiliary injuries after cholecystectomy highlights the need for constant alertness and prompt management in order to minimize the risk of the routine operative procedure. Hepatectomy with biliary and vascular reconstruction should be considered early in the management of vasculobiliary injury to avoid the development of life-threatening consequences.
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Affiliation(s)
- Stipislav Jadrijevic
- Department of Surgery, Division of Transplantation Surgery, University Hospital Merkur, Zagreb, Croatia
| | - Davorin Sef
- Department of Surgery, Division of Transplantation Surgery, University Hospital Merkur, Zagreb, Croatia
| | - Branislav Kocman
- Department of Surgery, Division of Transplantation Surgery, University Hospital Merkur, Zagreb, Croatia
| | - Anna Mrzljak
- Department of Medicine, University Hospital Merkur, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Hrvoje Matasic
- Department of Anesthesiology and Critical Care, University Hospital Merkur, Zagreb, Croatia
| | - Dinko Skegro
- Department of Medicine, University Hospital Merkur, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Guler N, Gunay Y, Dayangac M, Yaprak O, Akyildiz M, Yuzer Y, Tokat Y. Liver transplantation for fulminant hepatic failure due to iatrogenic porta hepatis injury. MINERVA CHIR 2013; 68:333-334. [PMID: 23774100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- N Guler
- Florence Nightingale Hospital, Liver Transplantation Center, Sisli, Istanbul, Turkey -
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Buabse FM, Palazzo A. [Right liver atrophy and cirrhosis due to an isolate portal vein injury]. Cir Esp 2012; 91:133-4. [PMID: 23219209 DOI: 10.1016/j.ciresp.2012.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 03/06/2012] [Accepted: 04/30/2012] [Indexed: 11/18/2022]
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Fujiki M, Ramirez JR, Aucejo FN. Duodenoportal fistula resulting from peptic ulcer after extended right hepatectomy for cholangiocarcinoma. Am Surg 2012; 78:E154-E155. [PMID: 22524745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Masato Fujiki
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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15
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Keleman AM, Imagawa DK, Findeiss L, Hanna MH, Tan VH, Katz MHG, Goodwin SC, Lane JS, Vajgrt D, Nguyen T, Smith CW. Associated vascular injury in patients with bile duct injury during cholecystectomy. Am Surg 2011; 77:1330-1333. [PMID: 22127081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Cholecystectomy remains one of the most commonly performed procedures in general surgery. Although the incidence, diagnosis, and treatment of bile duct (BD) injuries have been well described, studies characterizing associated vascular injuries are limited. The objective of this study was to analyze the frequency and management of associated vascular and BD injury after cholecystectomy. A total of 50 patients were referred to a tertiary institution for BD injuries from 1996 to 2010. Thirty-nine (78%) of the patients were female with the mean age of 49 years (range, 14 to 86 years). Seventy-five per cent of the injuries were Strasberg Type E. Nine patients (18%) had associated vascular injuries. Six patients had injuries to the right hepatic artery; in one patient, both the right and left hepatic arteries were damaged. Five patients had right portal vein injuries; three of these subsequently died. In conclusion, as a result of the high incidence of associated vascular injury, a thin-collimation CT angiogram and/or mesenteric angiogram with portal venous imaging should be considered as part of the preoperative evaluation in patients with BD injury.
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Affiliation(s)
- Alex M Keleman
- University of California, Irvine Medical Center, Orange, California, USA.
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Doi T, Kurahashi K, Goto T. [Case of hyperkalemia possibly caused by gabexate mesilate]. Masui 2010; 59:249-251. [PMID: 20169971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report a case of hyperkalemia in a recipient of living-related liver transplantation. The patient received a continuous infusion of gabexate mesilate at 60 mg x hr(-1) starting about 1 hr after the induction of anesthesia. The serum potassium concentration (K+) was increased from 4.53 mEq x l-(1) to 5.08 mEq x l(-1) within about 1 hr. Thereafter, a massive blood loss caused by an accidental damage of the portal vein necessitated rapid fluid therapy to maintain blood pressure. We observed an abnormal ECG recording including a wide QRS complex and a high T wave when about 30 units of leukocytes-reduced red cell concentrates had been transfused. Blood gas analysis showed high K+ (7.52 mEq x l(-1)) and metabolic acidosis (pH 7.167, base excess-12.5 mmol x l(-1)). We successfully controlled K+ with combination of therapies before causing any cardiac events to the patient. Gabexate mesilate is one possible cause of hyperkalemia in the present case because an increase in K+ was observed before transfusion, and transfusion might have augmented the effect. Gabexate mesilate is one of the protease inhibitors. Naphamostat mesilate, another protease inhibitor, is known to cause hyperkalemia by limiting potassium excretion from the kidney through an inhibition of Na/K-ATPase at the cortical collecting ducts. Although the mechanism by which gabexate mesilate causes hyperkalemia is unclear, it would be of benefit to use this drug cautiously, as it may cause hyperkalemia.
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Affiliation(s)
- Tomoki Doi
- Department of Anesthesia, Yokohama City University Hospital, Yokohama 236-0004
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Zaydfudim V, Wright JK, Pinson CW. Liver transplantation for iatrogenic porta hepatis transection. Am Surg 2009; 75:313-316. [PMID: 19385291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Iatrogenic porta hepatis transection is a rare but devastating surgical complication. There are no systematic studies examining the best treatment strategy in patients with this injury. We report two cases of transection of all three portal structures, one during an open right adrenalectomy and another during a laparoscopic cholecystectomy, both of which were transferred to our tertiary care center hours postinjury. Diagnostic imaging and exploration revealed nonsalvageable livers, and both patients underwent total hepatectomies and portocaval shunting. Donor livers were available 12 to 20 hours after United Network for Organ Sharing Status 1 listing and both patients survived their postoperative course with 2- and 6-year follow up to date. Two-stage total hepatectomy with portocaval shunting followed by liver transplantation should be considered for patients presenting with porta hepatis transection.
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Affiliation(s)
- Victor Zaydfudim
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2730, USA.
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18
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Kato LT, Poggetti RS, Fontes B, Massarollo PCB, Younes RN, Heimbecker AMDLC, Birolini D. Evaluation of the mortality rate caused by different periods of selective portal vein occlusion in rats. Acta Cir Bras 2008; 22:279-84. [PMID: 17625666 DOI: 10.1590/s0102-86502007000400009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Accepted: 04/10/2007] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED Mortality from acute selective portal vein occlusion (SPVO) is a matter of concern for surgeons during the management of traumatic portal vein injury. However, mortality rates related to different periods of SPVO remains undetermined. PURPOSE To determine the mortality rates resulting from different periods of acute SPVO in rats. METHODS Wistar male rats were randomized into 8 experimental, and 8 control groups. Experimental animals underwent SPVO during 15 to 75 minutes, and control groups underwent sham procedures. All surviving animals were followed up to 14 days for assessment of mortality rate. RESULTS Death rates varied from 0% in the 15 min SPVO group, to 100% with 65 and 75 minutes of SPVO. A strongly positive correlation was observed between mortality rates and SPVO periods (p<0.001) with either linear or quadratic regression analysis tests. All deaths in the 20 min and 25 min SPVO groups occurred after 75 min from the moment of clamping (or after 60 min from unclamping); death from 30 or more min SPVO occurred predominantly within 75 min from clamping moment (or within 60 min from unclamping). (Exact Fisher test, p=0.009). CONCLUSIONS The mortality from SPVO in rats increases with longer duration of SPVO; with deaths occurring later for short periods (<or= 25 min) of SPVO and earlier for longer periods (>or= 30 min) of SPVO.
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19
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Ferraioli G, Mariani G, Brunetti E, Filice C. Large intra-hepatic arterio-portal fistula following liver trauma. Ultraschall Med 2008; 29:339. [PMID: 18711672 DOI: 10.1055/s-0028-1082165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- G Ferraioli
- Infectious and Tropical Diseases Division, IRCCS S. Matteo Hospital Foundation, University of Pavia.
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20
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Karaaslan P, Pirat A, Karakayali H, Can U, Arslan G. Bilateral thalamic infarct after general anaesthesia for laparotomy: an unusual case of perioperative cryptogenic stroke. Acta Anaesthesiol Scand 2008; 52:316. [PMID: 18201319 DOI: 10.1111/j.1399-6576.2007.01526.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Mercado MA. [Iatrogenic lesions of the bile ducts. Role of the surgeon]. Rev Gastroenterol Mex 2007; 72 Suppl 2:148-153. [PMID: 18277505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Miguel Angel Mercado
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D.F
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Abstract
Laparoscopic cholecystectomy is associated with a two-to-four times higher risk of bile duct injury (BDI) than open cholecystectomy. BDI can lead to significant morbidity and even mortality. The first priority in BDI is to control peritoneal and biliary sepsis and to convert an acute BDI to a controlled external biliary fistula (EBF) - this can be achieved by endoscopic and/ or radiological intervention in most cases. This should be followed by assessment of the extent of injury - both biliary and vascular. Immediate management of BDI recognized during cholecystectomy depends on the type of injury, the condition of the patient, and the experience of the surgeon. For BDI recognized after cholecystectomy, early repair is not recommended, as the results are poor. The EBF may evolve into a benign biliary stricture (BBS), which should be electively repaired by a Roux-en-Y hepatico-jejunostomy. The use of an endoscopic stent as definitive management of BDI is not recommended. Long-term follow-up is essential after the repair of a BBS, as recurrence can occur several years after repair. Recurrent BBS is best treated with endoscopic balloon dilatation. Excellent early and long-term results can be obtained in specialized units at tertiary care referral centers.
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Affiliation(s)
- Vinay K Kapoor
- Department of Surgical Gastroenterology, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow, 226014, India
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23
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Ragozzino A, Lassandro F, De Ritis R, Imbriaco M. Value of MRI in three patients with major vascular injuries after laparoscopic cholecystectomy. Emerg Radiol 2007; 14:443-7. [PMID: 17497189 DOI: 10.1007/s10140-007-0617-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2007] [Accepted: 04/13/2007] [Indexed: 02/08/2023]
Abstract
The aim of this study was to describe three cases of major vascular injuries after laparoscopic cholecystectomy depicted on magnetic resonance (MR) examination. Three female patients (mean age, 32 years; range, 22-39 years) were studied with clinical suspicion of bilio-vascular injuries after laparoscopic cholecystectomy. All MR examinations were performed within 24 h after the laparoscopic procedure. MR imaging was evaluated for major vascular injuries involving the arterial and portal venous system, for bile duct discontinuity, presence or absence of biliary dilation, stricture, excision injury, free fluid and collections. In the first patient, a type-IV Bismuth injury with associated intrahepatic bile ducts dilation was observed. Contrast-enhanced MR revealed lack of enhancement in the right hepatic lobe due to occlusion of the right hepatic artery and the right portal branch. This patient underwent right hepatectomy with hepatico-jejunostomy. In the other two cases, no visualization of the right hepatic artery and the right portal branch was observed on MR angiography. In the first case, the patient underwent right hepatectomy; in the second case, because of stable liver condition, the patient was managed conservatively. MR imaging combined with MR angiography and MR cholangiography can be performed emergently in patients with suspicion of bilio-vascular injury after laparoscopic cholecystectomy allowing the simultaneous evaluation of the biliary tree and the hepatic vascular supply that is essential for adequate treatment planning.
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Affiliation(s)
- Alfonso Ragozzino
- Department of Radiology, Cardarelli Hospital and University Federico II, Via Pansini 5, Napoli, Italy
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24
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Paoli V, Durieux-Courbière M, Dumortier J, Pilleul F. [Portal dissection during TIPS placement]. J Radiol 2007; 88:687-8. [PMID: 17541363 DOI: 10.1016/s0221-0363(07)89877-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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25
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Felekouras E, Megas T, Michail OP, Papaconstantinou I, Nikiteas N, Dimitroulis D, Griniatsos J, Tsechpenakis A, Kouraklis G. Emergency liver resection for combined biliary and vascular injury following laparoscopic cholecystectomy: case report and review of the literature. South Med J 2007; 100:317-20. [PMID: 17396740 DOI: 10.1097/01.smj.0000242793.15923.1a] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A 75-year-old woman suffering from symptomatic cholelithiasis was admitted to our hospital for elective laparoscopic cholecystectomy (LC). Intraoperatively, because of severe inflammation and dense adhesions in the region of the Calot triangle and bleeding arising from the porta hepatis which obscured the operating field, the method was converted to a conventional open approach. Copious hemostasis was achieved using sutures, clips and diathermy, and no bile duct or vascular injuries were recognized intraoperatively. Because of severe right upper quadrant abdominal pain and significant deterioration of the liver function tests (LFTs) on the first postoperative day, the patient underwent a Doppler ultrasound scan which showed absence of blood flow at the level of porta hepatis. Urgent relaparotomy revealed an ischemic liver on the right, a transected common bile duct at the level of its confluence, a divided and ligated right hepatic artery and thrombosed portal vein down to its confluence. Thrombectomy and reconstruction of the portal vein were performed to salvage the left hemiliver, and after restoration of blood flow to the left hemiliver, a right hemihepatectomy and a Roux-en-Y hepaticojejunostomy on the left were performed. Liver resection serves an important role in the case of parenchymal necrosis due to combined biliary, hepatic artery and portal vein injury following laparoscopic cholecystectomy and moreover, the operation can be safely performed in the acute setting.
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Affiliation(s)
- Evangelos Felekouras
- Department of Surgery, University of Athens, Medical School, LAIKO Hospital, Athens, Greece
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26
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Abstract
BACKGROUND Portal vein thrombosis is rare following Roux-en-Y gastric bypass (RYGBP). Its natural history is dependent on the etiology of the thrombosis. Iatrogenic injuries at bariatric operations resulting in portal vein thrombosis are lethal complications typically necessitating a liver transplant, whereas postoperative portal vein thrombosis without an injury to the portal vein has a benign course. There are currently no data on management or prognostic factors of portal vein thrombosis after bariatric operations. METHODS 3 patients referred for liver transplantation secondary to portal vein injury following bariatric surgery between 2000 and 2003 are presented. RESULTS 2 super-obese (BMI>or=50 kg/m2) and 1 morbidly obese (BMI 44 kg/m2) patients sustained portal vein injuries during bariatric surgery (RYGBP 2, VBG 1) by experienced bariatric surgeons. In each case, the portal injury was identified and repaired. Thrombosis followed reconstruction in all 3 patients. All 3 underwent emergency liver transplantation, but died of sepsis and multi-organ failure following transplantation. Review of the literature found no cases of traumatic portal vein injuries following bariatric operations and 2 cases of postoperative portal vein thrombosis: 1 following LRYGBP (BMI 46) and one after a Lap-Band (BMI 41). CONCLUSION Injury to the portal vein resulting from difficulty in discerning the anatomy of the intra-abdominal structures in the morbidly obese, is a lethal complication of bariatric surgery. Super-obese patients submitting to bariatric surgery should lose weight, undergo a two-stage bariatric procedure, or undergo laparoscopic RYGBP to minimize the risk of portal injury. Postoperative portal vein thrombosis has a benign course and can be managed conservatively.
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Affiliation(s)
- Sergio Huerta
- University of Texas Southwestern Medical Center/VA North Texas Health Care System, Dallas, TX 75216, USA.
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27
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Laopaiboon V, Aphinives C, Pugkem A, Thummaroj J, Puttharak W, Soommart Y. Selective transcatheter embolization for treatment of post-traumatic hepatic artery and portal vein pseudoaneurysms. J Med Assoc Thai 2006; 89:248-52. [PMID: 16579014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The authors report a case of post-traumatic hepatic artery and portal vein pseudoaneurysms caused by blunt abdominal trauma, with multiple organ injuries including liver laceration. Abdominal spiral CT, CDS and DSA were performed to confirm the diagnosis. Both pseudoaneurysms were treated successfully with selective transcatheter embolization.
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Affiliation(s)
- Vallop Laopaiboon
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
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28
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Singh R, Kaushik R, Sharma R, Attri AK. Non-biliary mishaps during laparoscopic cholecystectomy. Indian J Gastroenterol 2004; 23:47-9. [PMID: 15176534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The most important complications of laparoscopic cholecystectomy (LC) are biliary tract injuries. Non-biliary complications can be equally devastating, but have received less attention in literature. METHODS The case files of 1748 patients who underwent LC over a period of seven years (1997-2003) in our department were retrospectively reviewed to identify non-biliary complications and their management. RESULTS Nine patients (0.5%) sustained significant non-biliary injury while undergoing LC. The commonest was duodenal perforation during dissection of the Calot's triangle (3 cases). Other complications included diaphragmatic injury (2 cases), and small bowel injury while inserting the umbilical port, right external iliac artery injury during insertion of Veress needle, portal vein injury during dissection, and liver laceration while using a delivery system to extract the gall bladder (1 each). All these complications were detected and managed intra-operatively. During the same period, 10 patients sustained biliary injury. CONCLUSION Intra-operative non-biliary injuries during LC occur as frequently as biliary injuries, and can be life-threatening and difficult to manage.
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Affiliation(s)
- Rajdeep Singh
- Department of Surgery, Government Medical College and Hospital, Sector 32, Chandigarh 160 030.
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29
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Affiliation(s)
- A Krajina
- Department of Radiology, University Hospital, 500 05 Hradec Kralove, Czech Republic.
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30
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Oderich GS, Panneton JM, Hofer J, Bower TC, Cherry KJ, Sullivan T, Noel AA, Kalra M, Gloviczki P. Iatrogenic operative injuries of abdominal and pelvic veins: a potentially lethal complication. J Vasc Surg 2004; 39:931-6. [PMID: 15111840 DOI: 10.1016/j.jvs.2003.11.040] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Epidemiologic studies of vascular injuries are usually limited to those caused by trauma. The purpose of this study was to review the management and clinical outcome in patients with operative injuries to abdominal and pelvic veins. METHODS Clinical data and outcome in all patients with iatrogenic venous injuries during abdominal and pelvic operations between 1985 and 2002 were reviewed. RESULTS Forty patients (21 men, 19 women; mean age, 51 years [range, 27-87 years]) sustained 44 venous injuries. Injuries occurred during general (30%), colorectal (23%), orthopedic (20%), gynecologic (15%), and other (12%) operations. Factors leading to injury included oncologic resection (65%), difficult anatomic exposure (63%), previous operation (48%), recurrent tumor (28%), and radiation therapy (20%). All patients had substantial bleeding (mean, 3985 mL; range, 500-20,000 mL). Injuries were located in the inferior vena cava (n = 6), portal vein (n = 7), renal vein (n = 1), and iliac vein (n = 30). Repair was performed with venorrhaphy (64%), end-to-end anastomosis (14%), interposition graft (20%), and vessel ligation (2%). Seven patients (18%) died of injury-related causes, including multisystem organ failure (n = 4), uncontrollable bleeding (n = 2), and pulmonary embolism (n = 1). Thirteen patients (32.5%) had major injury-related complications, including repeat exploration because of bleeding (n = 6), multisystem organ failure (n = 6), and venous thrombosis (n = 4). In two patients (5%) unilateral lower extremity edema developed, with no evidence of thrombosis. There was no late graft or venous thrombosis. Variables associated with increased risk for death were massive bleeding, acidosis, hypotension, and hypothermia (P <.05). CONCLUSION Operative injuries of abdominal and pelvic veins occur in patients undergoing oncologic resection and those with difficult anatomic exposure, owing to previous operation, recurrent tumor, or radiation therapy. Massive blood loss, acidosis, hypotension, and hypothermia are associated with increased risk for death. Repair of venous injuries offers durable results with low incidence of graft or venous thrombosis.
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31
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Abstract
BACKGROUND Injuries to the portal vein are rare but devastating. Contemporary studies have debated the most effective management for this injury. The purpose of this case study was to provide an update on portal vein injury and add information regarding its management. METHODS A retrospective review investigated the 10-year experience with portal vein injury in a level 1 trauma center. RESULTS Of the 18,900 trauma patients (0.08%) evaluated during a 10-year period, 15 sustained injuries to the portal vein. All the injuries resulted from penetrating trauma, and the overall survival rate was 60% (9 of the 15 patients). Four patients died of exsanguination and two patients died later as a result of multisystem organ failure. Postoperative complications were common. Sepsis and wound infection were the most common postoperative complications, occurring in seven (78%) of the nine survivors. All the patients had associated nonvascular injuries, whereas 9 (60%) of the 15 had associated vascular injuries. Associated injuries to the other structures in the portal triad occurred in 7 (47%) of the 15 patients, and 5 (71%) of these patients survived. Survival rates by procedure were 86% for venorrhaphy and 67% for ligation. CONCLUSIONS Injuries to the portal vein are rare. In this study, exsanguination was the main cause of death. The key to a favorable outcome is prompt control of hemorrhage with an early decision to proceed with either venorrhaphy or ligation. Ligation can be effective for the management of hemodynamically unstable patients.
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Affiliation(s)
- Jonathan Pearl
- Department of Surgery, National Naval Medical Center, Bethesda, Maryland, USA
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32
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Agaev BA, Rustamov EA, Dzhafarov ZM, Mamedov KB, Novruzova SA. [A knife wound of the abdomen with simultaneous injury of the portal and inferior cava veins]. Khirurgiia (Mosk) 2004:48. [PMID: 15446264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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33
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Kerlan RK, LaBerge JM, Wilson MW, Gordon RL, Kirkwood K, Sawhney R. SIR 2003 film panel case 5: massive hemorrhage from portal vein disruption. J Vasc Interv Radiol 2003; 14:797-802. [PMID: 12817050 DOI: 10.1097/01.rvi.0000079993.80153.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Robert K Kerlan
- Department of Radiology, University of California, San Francisco 94143, USA.
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34
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Lewin M, Pocard M, Caplin S, Blain A, Tubiana JM, Parc R. Benign hepatic portal venous gas following caustic ingestion. Eur Radiol 2002; 12 Suppl 3:S59-61. [PMID: 12522605 DOI: 10.1007/s00330-002-1543-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2001] [Revised: 03/15/2002] [Accepted: 05/03/2002] [Indexed: 11/26/2022]
Abstract
Hepatic portal vein gas has been documented in numerous conditions and is traditionally regarded as a poor prognostic sign. There are, however, several reports of portal vein gas with a benign course. We report the first case of transient hepatic portal vein gas secondary to the ingestion of a caustic substance. The literature of hepatic portal vein gas in benign disease is reviewed.
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Affiliation(s)
- Maïté Lewin
- Department of Radiology, Saint Antoine University Hospital, 184 rue du Faubourg Saint Antoine, 75012 Paris, France.
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35
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Broering DC, Al-Shurafa HA, Mueller L, Pothmann W, Nierhaus A, Rogiers X. Total vascular isolation and in situ cold perfusion for management of severe liver trauma. J Trauma 2002; 53:564-7. [PMID: 12352498 DOI: 10.1097/00005373-200209000-00028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Dieter C Broering
- Department of Hepatobiliary Surgery, University Hospital of Hamburg-Eppendorf, University of Hamburg, Germany.
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36
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Abstract
The purpose of this study was to analyze apoptosis in the vessel wall after stent implantation in the canine portal vein and also to investigate the expression of the p21 cyclin-dependent kinase inhibitor, which may regulate cellular proliferation after vascular injury. Uninjured, control veins had few detectable TUNEL-positive cells in the intima and media (0.829 +/- 0.413%). At 4 weeks after stent implantation, TUNEL-positive cells significantly increased to 50.5 +/- 4.639%. These cells were predominantly located around the stent struts, and appeared to be smooth muscle cells morphologically. At 12 weeks, 44.7 +/- 6.178% of the intimal and medial cells were still TUNEL positive, and there was no significant difference between 4 and 12 weeks. P21 was not detected in uninjured, normal veins. At 4 and 12 weeks after stent implantation, positive p21 immunostaining was sparsely expressed in the intima and media adjacent to the stent struts. Thus, stent implantation induced a prolonged apoptotic response and increased expression of p21 in the portal venous system. This prolonged apoptotic response, possibly regulated by p21, may have a significant role in modulating the cellularity of intimal formation.
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Affiliation(s)
- Fabio Akimaro Kudo
- Department of Cardiovascular Surgery, Hokkaido University School of Medicine, Hokkaido, Japan
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37
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Abstract
Wounds of the portal vein are caused most commonly by penetrating trauma and carry a very high mortality rate. Most deaths are caused by exsanguination, occurring intraoperatively as surgeons struggle to control the hemorrhage from the portal vein and associated vascular injuries. A thorough knowledge of the anatomy of the area and of the likely patterns of wounding is important. At surgery, surgeons must be prepared to deal with multiple vessel wounding. Although most investigators have advocated lateral repair of the portal vein when it can be accomplished, portal ligation seems to be a safe alternative. Complex repairs are justified only when a contraindication to ligation exists. Postoperative care must recognize the need for extraordinary fluid replacement and the small risk for postoperative bowel infarction after repair or ligation of the portal vein.
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Affiliation(s)
- R F Buckman
- Department of Surgery, Temple University School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania 19140, USA
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38
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Abstract
Temporary occlusion with an angioplasty balloon can stop intraperitoneal bleeding.
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Affiliation(s)
- J K Kim
- Department of Radiology, Chonnam University School of Medicine, Kwangju, Korea.
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39
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Yu JS, Kim KW, Park MS, Yoon SW. Bile duct injuries leading to portal vein obliteration after transcatheter arterial chemoembolization in the liver: CT findings and initial observations. Radiology 2001; 221:429-36. [PMID: 11687687 DOI: 10.1148/radiol.2212010339] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To document the computed tomographic (CT) findings of transcatheter arterial chemoembolization (TACE)-induced, localized bile duct injuries leading to portal vein branch obliteration in the liver and to elucidate the clinical implications with retrospective review of the authors' experiences. MATERIALS AND METHODS Follow-up CT scans obtained in 11 patients with TACE-induced intrahepatic bile duct dilatation were reviewed retrospectively to evaluate serial changes in the adjacent portal vein branches and hepatic parenchyma. Clinical data, including time between TACE and CT and serum alkaline phosphatase levels, also were analyzed. RESULTS Of 11 patients with marked (n = 8) or mild (n = 3), lobar (n = 4) or segmental (n = 7) bile duct dilatation with or without bile collection in the tissue sheaths of the Glisson capsule or hepatic parenchyma, nine (82%) had bile duct changes at the first CT follow-up, within 1 month after TACE. Marked narrowing or obliteration of the adjacent intrahepatic portal vein branches in 10 (91%) patients resulted in progressive atrophy of the corresponding hepatic parenchyma in nine (82%) at variable times after TACE. The serum alkaline phosphatase level increased to more than 200 U/L in eight (89%) of nine patients 1 month after TACE. CONCLUSION TACE-induced intrahepatic bile duct injury resulting in obliteration of the adjacent portal vein branch seems to be one cause of hepatic parenchymal atrophic changes after TACE.
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Affiliation(s)
- J S Yu
- Department of Diagnostic Radiology and the Research Institute of Radiological Science, Yonsei University College of Medicine, YongDong Severance Hospital, 146-92 Dogok-Dong, Gangnam-Gu, Seoul 135-270, South Korea.
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40
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Abstract
Traumatic arterioportal fistulas are rare lesions in the pediatric age group. This case highlights the safe and effective management of intrahepatic arterioportal fistulas by transcatheter coil embolization.
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Affiliation(s)
- J R Bapuraj
- Department of Radiodiagnosis & Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India.
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41
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Wong MD, Lucas CE. Liver infarction after laparoscopic cholecystectomy injury to the right hepatic artery and portal vein. Am Surg 2001; 67:410-1. [PMID: 11379637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
A 66-year-old woman presented with fever and right upper quadrant pain 5 weeks after laparoscopic cholecystectomy. Angiogram revealed occlusion of the right hepatic artery and right portal vein which necessitated a right hepatic lobectomy. To our knowledge this has not been previously reported. The patient recovered uneventfully.
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Affiliation(s)
- M D Wong
- Department of Surgery, Wayne State University, Detroit, Michigan 48201, USA
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42
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Affiliation(s)
- J J Hewett
- Department of Radiology, Box 3808, Duke University Medical Center, Durham, NC 27710, USA
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43
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Abstract
Traumatic arterioportal fistulas (APF) are very rare. The most common reasons are liver biopsy and liver injuries. They are also caused by liver tumours and vessel anomalies. This is a case-report of a patient who developed an APF after blunt abdominal trauma. The fistula bearing part of the liver was resected in two sessions. In cases of large APFs with a flow from multiple collaterals the therapy of choice is the embolization. If not possible a selective excision of the fistulous sac or the resection of the fistula containing liver segment are recommended.
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Affiliation(s)
- U Eickhoff
- Chirurgische Abteilung, Evangelischen Krankenhauses Herne
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44
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Affiliation(s)
- L Berlin
- Department of Radiology, Rush North Shore Medical Center, Skokie, IL 60076, USA
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45
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Abstract
During a transjugular portosystemic stent-shunt (TIPSS) procedure a portal vein laceration occurred with subsequent intraperitoneal hemorrhage. A PTFE-covered nitinol stent was successfully placed eliminating the leak and creating a functioning portosystemic shunt. This case demonstrates both the importance of portal vein puncture more than 1 cm from the bifurcation and the necessity of maintaining a stock of available stent-grafts.
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Affiliation(s)
- R J Owen
- Department of Clinical Radiology, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
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46
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Birth M, Lossin P, Brugmans F, Weiser HF. Vascular injuries within the hepatoduodenal ligament: recognition by laparoscopic color Doppler ultrasound. Surg Endosc 2000; 14:246-9. [PMID: 10741442 DOI: 10.1007/s004640000028] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lesions of vascular structures are rare but serious complications of laparoscopic cholecystectomy. The purpose of this blind randomized animal study was to investigate the possibility of detecting different vascular lesions within the hepatoduodenal ligament using laparoscopic color Doppler ultrasound (LCDU). METHODS Twenty-four lesions of the hepatic artery and portal vein were created laparoscopically in six farmer pigs using titanium clips. The following injuries were studied: (a) partial occlusion of the hepatic artery (eight cases), (b) complete occlusion of the hepatic artery (eight cases), (c) partial occlusion of the portal vein (eight cases). There were also eight cases without lesions of the vascular vessels. The order in which the injuries were created was randomly assigned. The study was performed in a blind fashion. Recognition of the injuries was attempted with LCDU. RESULTS All injuries were recognized correctly by LCDU. There were no false positive results. The clips were reliably located. Using color Doppler imaging, partial occlusions of the hepatic artery and portal vein were visualized by changes of the blood flow from laminar to turbulent behind the clip. Complete occlusion of the hepatic artery was recognized as a complete cessation of the colored blood flow. CONCLUSION LCDU is a very efficient tool for visualizing vascular structures and evaluating the bloodstream. Partial or complete vascular occlusion by clips that may occur as a result of difficult dissection during laparoscopic cholecystectomy can be visualized reliably using this technique.
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Affiliation(s)
- M Birth
- Department of Surgery, Medical University of Lübeck, Germany
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Abstract
Dissection of the portal vein is a rare entity which has been rarely described during transjugular intrahepatic portosystemic shunt (TIPS) procedure. We report three cases of dissection during this procedure and their complications. One dissection was immediately treated with coaxial stents. The two others were complicated either by a thrombus or by a false aneurysm. In the first case a second parallel stent was used to treat this complication. The patient with the portal vein false aneurysm was transplanted 4 days after this diagnosis. Portal vein dissection in TIPS procedure appeared to be less rare than has been reported and must be considered as a potential cause of TIPS dysfunction.
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Affiliation(s)
- P Petit
- Service Central de Radiologie et Imagerie Médicale, Groupe Hospitalier de la Timone, Marseille, France
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Brountzos EN, Alexopoulou E, Koskinas I, Thanos L, Papathanasiou MA, Kelekis DA. Intraperitoneal portal vein bleeding during transjugular intrahepatic portosystemic shunt: treatment with stent-graft placement. AJR Am J Roentgenol 2000; 174:132-4. [PMID: 10628468 DOI: 10.2214/ajr.174.1.1740132] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- E N Brountzos
- Second Department of Radiology, Medical School, Athens University, Eugenidion Hospital, Greece
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49
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de Mestier P. [Congress of the American College of Surgeons (ACS). San Francisco, 10-15 October 1999]. J Chir (Paris) 1999; 136:353-5. [PMID: 10675826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- P de Mestier
- Service de Chirurgie Générale, Hôpital des Gardiens de la paix, Paris
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Adamus R, Loose R, Beyer-Enke S. [Stent migration with perforation of the portal vein after transjugular intrahepatic portosystemic shunt (TIPS) with a self-expanding stent]. ROFO-FORTSCHR RONTG 1999; 171:174-6. [PMID: 10506898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
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