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Retained Foreign Body in Transplanted Liver.

Kayaalp C, Kırmızı S, Kutlu R, Yagci MA, Isik B, Yilmaz S - Int J Organ Transplant Med (2015)

Bottom Line: A 10-F Nelaton catheter, 5-cm long, was removed from the portal vein by surgery.Retrospectively, we understood that the portal vein was cut during the back-table procedure and the portal vein catheter was replaced with a larger one for better irrigation.Most probably, the original catheter was cut together with the portal vein, and the tip of the catheter was retained in the portal system and migrated into the liver.

View Article: PubMed Central - PubMed

Affiliation: Inonu University, Liver Transplantation Institute, Malatya, Turkey.

ABSTRACT
Liver transplantation is a technically complex and long surgical procedure. A large quantity of various materials such as catheters, sutures, needles and clips are frequently used during the procedure. These materials may enter in the liver from the vascular or biliary orifices inadvertently. A 50-year-old patient who had hepatic failure due to HBV underwent a deceased-donor liver transplantation. The deceased donor was a 75-year-old HbsAg(+) man. The recipient had subfebrile fever and leukocytosis post-operatively. A control computed tomography revealed a cuneiform ischemic area, and a foreign body inside the right anterior portal vein branch proximal to this ischemic region. A 10-F Nelaton catheter, 5-cm long, was removed from the portal vein by surgery. Retrospectively, we understood that the portal vein was cut during the back-table procedure and the portal vein catheter was replaced with a larger one for better irrigation. Most probably, the original catheter was cut together with the portal vein, and the tip of the catheter was retained in the portal system and migrated into the liver. As far as we know, such a complication of liver transplantation has never been described previously.

No MeSH data available.


Related in: MedlinePlus

The foreign body removed from the anterior branch of the right portal vein
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Figure 2: The foreign body removed from the anterior branch of the right portal vein

Mentions: Brain death occurred due to subarachnoid hemorrhage in a 75-year-old, HbsAg+ donor in another transplant center and the local transplant center did not accept this marginal graft. Local transplant team harvested the graft and sent it to our center within nine hours. Back-table procedure was performed in our center and the graft was transplanted to a 50-year-old, HbsAg+ patient who had chronic hepatic failure. There were no intra-operative complications. In the post-operative period, however, an increase in leukocyte count and fever were seen. Abdominal computed tomography on the 9th day revealed a cuneiform ischemic area in the right liver lobe. There was a thin, long foreign body inside the anterior branch of the portal vein supplying this lobe (Fig 1). Removal of the catheter by interventional radiology was though but found more difficult than its surgical removal. Re-laparotomy on day 10 revealed the ischemic area in the right lobe. The portal vein was opened from an extra-anastomotic area in a transverse plane under total hepatic vascular occlusion and a 10-F catheter piece, 5-cm long, was removed using a clamp from the anterior branch of the right portal vein (Fig 2). The portal vein was closed primarily. The fever subsided and the leukocyte count was normalized. There were no complication and the patient was discharged on the 18th day uneventfully. A control computed tomography on day 40 revealed that the necrotic area had regressed.


Retained Foreign Body in Transplanted Liver.

Kayaalp C, Kırmızı S, Kutlu R, Yagci MA, Isik B, Yilmaz S - Int J Organ Transplant Med (2015)

The foreign body removed from the anterior branch of the right portal vein
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4644572&req=5

Figure 2: The foreign body removed from the anterior branch of the right portal vein
Mentions: Brain death occurred due to subarachnoid hemorrhage in a 75-year-old, HbsAg+ donor in another transplant center and the local transplant center did not accept this marginal graft. Local transplant team harvested the graft and sent it to our center within nine hours. Back-table procedure was performed in our center and the graft was transplanted to a 50-year-old, HbsAg+ patient who had chronic hepatic failure. There were no intra-operative complications. In the post-operative period, however, an increase in leukocyte count and fever were seen. Abdominal computed tomography on the 9th day revealed a cuneiform ischemic area in the right liver lobe. There was a thin, long foreign body inside the anterior branch of the portal vein supplying this lobe (Fig 1). Removal of the catheter by interventional radiology was though but found more difficult than its surgical removal. Re-laparotomy on day 10 revealed the ischemic area in the right lobe. The portal vein was opened from an extra-anastomotic area in a transverse plane under total hepatic vascular occlusion and a 10-F catheter piece, 5-cm long, was removed using a clamp from the anterior branch of the right portal vein (Fig 2). The portal vein was closed primarily. The fever subsided and the leukocyte count was normalized. There were no complication and the patient was discharged on the 18th day uneventfully. A control computed tomography on day 40 revealed that the necrotic area had regressed.

Bottom Line: A 10-F Nelaton catheter, 5-cm long, was removed from the portal vein by surgery.Retrospectively, we understood that the portal vein was cut during the back-table procedure and the portal vein catheter was replaced with a larger one for better irrigation.Most probably, the original catheter was cut together with the portal vein, and the tip of the catheter was retained in the portal system and migrated into the liver.

View Article: PubMed Central - PubMed

Affiliation: Inonu University, Liver Transplantation Institute, Malatya, Turkey.

ABSTRACT
Liver transplantation is a technically complex and long surgical procedure. A large quantity of various materials such as catheters, sutures, needles and clips are frequently used during the procedure. These materials may enter in the liver from the vascular or biliary orifices inadvertently. A 50-year-old patient who had hepatic failure due to HBV underwent a deceased-donor liver transplantation. The deceased donor was a 75-year-old HbsAg(+) man. The recipient had subfebrile fever and leukocytosis post-operatively. A control computed tomography revealed a cuneiform ischemic area, and a foreign body inside the right anterior portal vein branch proximal to this ischemic region. A 10-F Nelaton catheter, 5-cm long, was removed from the portal vein by surgery. Retrospectively, we understood that the portal vein was cut during the back-table procedure and the portal vein catheter was replaced with a larger one for better irrigation. Most probably, the original catheter was cut together with the portal vein, and the tip of the catheter was retained in the portal system and migrated into the liver. As far as we know, such a complication of liver transplantation has never been described previously.

No MeSH data available.


Related in: MedlinePlus