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The modified Sugiura procedure as bridge surgery for liver transplantation: a case report.

Feng AC, Liao CY, Fan HL, Chen TW, Hsieh CB - J Med Case Rep (2015)

Bottom Line: He then received a living donor liver transplantation with the right lobe of liver from his daughter.The postoperative course was uneventful, and he was discharged two weeks later.He had no evidence of recurrent esophagogastric varices bleeding during the six-month follow-up.

View Article: PubMed Central - PubMed

Affiliation: Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei, 11490, Taiwan. angela20590@gmail.com.

ABSTRACT

Introduction: Esophagogastric varices bleeding is a common complication due to portal hypertension in patients with liver cirrhosis. With the advancement of nonoperative management including vasoactive agents, endoscopic hemostasis or transjugular intrahepatic portosystemic shunt, surgical management has played a lesser role in recent decades. The present report describes a patient with hepatitis B (HBV)-related liver cirrhosis and portal vein thrombosis with recurrent esophagogastric varices bleeding despite the use of medical and endoscopic therapy. The modified Sugiura procedure was performed as an alternative bridge surgery for liver transplantation in order not to change the anatomic structure of the great vessels and to avoid hepatic encephalopathy related to shunting procedures like the transjugular intrahepatic portosystemic shunt.

Case presentation: A 56-year-old Chinese man with a history of portal hypertension due to HBV-related liver cirrhosis and known former recurrent esophageal varices bleeding status post Sengstaken-Blakemore tube tamponade was referred to our hospital for liver transplantation evaluation because of persistent esophagogastric varices bleeding with hypovolemic shock, even after medical and endoscopic therapies in a local hospital. As a result, liver cirrhosis with Child-Pugh class B function was diagnosed. Despite the use of vasoactive agents, and endoscopic hemostasis management, esophagogastric varices bleeding still occurred episodically with hypovolemic shock, which could not be reversed by blood transfusion or Sengstaken-Blakemore tube tamponade. The modified Sugiura procedure, as an alternative bridge therapy for patients who are candidates for liver transplantation, was performed, despite the fact that his liver transplantation was not yet completed. He then received a living donor liver transplantation with the right lobe of liver from his daughter. The postoperative course was uneventful, and he was discharged two weeks later. He had no evidence of recurrent esophagogastric varices bleeding during the six-month follow-up.

Conclusions: The treatment experience of this case gave us not only the idea but also the practical way of applying the modified Sugiura operation as a bridge and rescue therapy without alteration of the vascular anatomy and hemodynamic stability for patients who have experienced refractory esophagogastric varices bleeding, despite the use of medication and endoscopic treatment, and are candidates for receiving a liver transplantation.

No MeSH data available.


Related in: MedlinePlus

Preoperative imaging study of the abdomen. (A) A magnetic resonance imaging scan showed the relatively small size of the portal vein in both hepatic lobes, which may have been due to the hepatofugal flow or stasis flow causing thrombosis. (B) A computed tomography scan done in the previous hospital revealed the presence of a long segment of portal vein thrombosis (white arrowhead).
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Fig1: Preoperative imaging study of the abdomen. (A) A magnetic resonance imaging scan showed the relatively small size of the portal vein in both hepatic lobes, which may have been due to the hepatofugal flow or stasis flow causing thrombosis. (B) A computed tomography scan done in the previous hospital revealed the presence of a long segment of portal vein thrombosis (white arrowhead).

Mentions: A 56-year-old Chinese man with a history of portal hypertension due to HBV-related liver cirrhosis and known former recurrent esophageal varices bleeding status post Sengstaken-Blakemore tube tamponade was referred to our hospital for liver transplantation evaluation because of persistent EV bleeding with hypovolemic shock, even after medical and endoscopic therapies in a local hospital. On admission, he was hemodynamically unstable and was transferred to the intensive care unit for close monitoring. Grade I encephalopathy and mild ascites were noted during a physical examination, and the serum laboratory tests disclosed hemoglobin 10.2g/dL, total bilirubin 3.3mg/dL, albumin 3.4g/dL, ammonia 220ug/dL, and a prothrombin time of 33.6 seconds. As a result, liver cirrhosis with Child-Pugh class B function was diagnosed. An upper gastrointestinal endoscopy revealed F2 esophageal varices with a healed ulcer, M/3 to L/3, and a magnetic resonance imaging (MRI) scan showed the relatively small size of the portal vein in both hepatic lobes, which may have been due to the hepatofugal flow or stasis flow causing thrombosis (Figure 1A). Besides, a computed tomography (CT) scan done in the previous hospital revealed the presence of a long segment of portal vein thrombosis (Figure 1B).Figure 1


The modified Sugiura procedure as bridge surgery for liver transplantation: a case report.

Feng AC, Liao CY, Fan HL, Chen TW, Hsieh CB - J Med Case Rep (2015)

Preoperative imaging study of the abdomen. (A) A magnetic resonance imaging scan showed the relatively small size of the portal vein in both hepatic lobes, which may have been due to the hepatofugal flow or stasis flow causing thrombosis. (B) A computed tomography scan done in the previous hospital revealed the presence of a long segment of portal vein thrombosis (white arrowhead).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4362827&req=5

Fig1: Preoperative imaging study of the abdomen. (A) A magnetic resonance imaging scan showed the relatively small size of the portal vein in both hepatic lobes, which may have been due to the hepatofugal flow or stasis flow causing thrombosis. (B) A computed tomography scan done in the previous hospital revealed the presence of a long segment of portal vein thrombosis (white arrowhead).
Mentions: A 56-year-old Chinese man with a history of portal hypertension due to HBV-related liver cirrhosis and known former recurrent esophageal varices bleeding status post Sengstaken-Blakemore tube tamponade was referred to our hospital for liver transplantation evaluation because of persistent EV bleeding with hypovolemic shock, even after medical and endoscopic therapies in a local hospital. On admission, he was hemodynamically unstable and was transferred to the intensive care unit for close monitoring. Grade I encephalopathy and mild ascites were noted during a physical examination, and the serum laboratory tests disclosed hemoglobin 10.2g/dL, total bilirubin 3.3mg/dL, albumin 3.4g/dL, ammonia 220ug/dL, and a prothrombin time of 33.6 seconds. As a result, liver cirrhosis with Child-Pugh class B function was diagnosed. An upper gastrointestinal endoscopy revealed F2 esophageal varices with a healed ulcer, M/3 to L/3, and a magnetic resonance imaging (MRI) scan showed the relatively small size of the portal vein in both hepatic lobes, which may have been due to the hepatofugal flow or stasis flow causing thrombosis (Figure 1A). Besides, a computed tomography (CT) scan done in the previous hospital revealed the presence of a long segment of portal vein thrombosis (Figure 1B).Figure 1

Bottom Line: He then received a living donor liver transplantation with the right lobe of liver from his daughter.The postoperative course was uneventful, and he was discharged two weeks later.He had no evidence of recurrent esophagogastric varices bleeding during the six-month follow-up.

View Article: PubMed Central - PubMed

Affiliation: Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei, 11490, Taiwan. angela20590@gmail.com.

ABSTRACT

Introduction: Esophagogastric varices bleeding is a common complication due to portal hypertension in patients with liver cirrhosis. With the advancement of nonoperative management including vasoactive agents, endoscopic hemostasis or transjugular intrahepatic portosystemic shunt, surgical management has played a lesser role in recent decades. The present report describes a patient with hepatitis B (HBV)-related liver cirrhosis and portal vein thrombosis with recurrent esophagogastric varices bleeding despite the use of medical and endoscopic therapy. The modified Sugiura procedure was performed as an alternative bridge surgery for liver transplantation in order not to change the anatomic structure of the great vessels and to avoid hepatic encephalopathy related to shunting procedures like the transjugular intrahepatic portosystemic shunt.

Case presentation: A 56-year-old Chinese man with a history of portal hypertension due to HBV-related liver cirrhosis and known former recurrent esophageal varices bleeding status post Sengstaken-Blakemore tube tamponade was referred to our hospital for liver transplantation evaluation because of persistent esophagogastric varices bleeding with hypovolemic shock, even after medical and endoscopic therapies in a local hospital. As a result, liver cirrhosis with Child-Pugh class B function was diagnosed. Despite the use of vasoactive agents, and endoscopic hemostasis management, esophagogastric varices bleeding still occurred episodically with hypovolemic shock, which could not be reversed by blood transfusion or Sengstaken-Blakemore tube tamponade. The modified Sugiura procedure, as an alternative bridge therapy for patients who are candidates for liver transplantation, was performed, despite the fact that his liver transplantation was not yet completed. He then received a living donor liver transplantation with the right lobe of liver from his daughter. The postoperative course was uneventful, and he was discharged two weeks later. He had no evidence of recurrent esophagogastric varices bleeding during the six-month follow-up.

Conclusions: The treatment experience of this case gave us not only the idea but also the practical way of applying the modified Sugiura operation as a bridge and rescue therapy without alteration of the vascular anatomy and hemodynamic stability for patients who have experienced refractory esophagogastric varices bleeding, despite the use of medication and endoscopic treatment, and are candidates for receiving a liver transplantation.

No MeSH data available.


Related in: MedlinePlus