Living Donor Liver Transplantation for Iatrogenic Vascular Injury During Laparoscopic Cholecystectomy: Case Report.

Adem Tuncer, Canan Dilay Dirican, Emrah Sahin, Veysel Ersan, Bulent Unal, Abuzer Dirican
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Abstract

Acute liver failure (ALF) caused by hepatic vascular injury during cholecystectomy is a rare but serious indication of liver transplantation (LT). We present a case of acute liver failure secondary to portal vein, hepatic artery, and common bile duct injury during laparoscopic cholecystectomy, requiring a same-day emergency living donor liver transplantation (LDLT). A 57-year-old man underwent elective laparoscopic cholecystectomy at an external facility. During the operation, uncontrolled bleeding from the liver hilum led to conversion to open surgery. Despite attempts to control the bleeding with sutures, the patient developed abnormal liver enzymes postoperatively. A computed tomography scan revealed necrosis of the right liver lobe and hypoplasia of the left lobe, leading to the patient to be transferred to our center. Upon admission, the patient was found to have encephalopathy, coagulopathy, hypotension, and oliguria, with elevated transaminase levels. Based on these findings, an emergency LT was deemed necessary. Due to the unavailability of a cadaveric organ, the patient's daughter was prepared as a living donor. Exploratory laparotomy revealed a necrotic right liver lobe, atrophic left lobe, transection of the right hepatic artery and common bile duct, and a thrombosed right portal vein. The patient successfully underwent LDLT from his daughter within 24 hours. At the seventh-month follow-up, he had no complications. Hepatic vascular injury during laparoscopic cholecystectomy can lead to ALF, which carries a high mortality risk. In such cases, LDLT may be a life-saving strategy. Early referral of a patient with ALF to a transplant center is life-saving.

活体供肝移植治疗腹腔镜胆囊切除术中医源性血管损伤一例报告。
胆囊切除术中肝血管损伤引起的急性肝衰竭(ALF)是一种罕见但严重的肝移植指征。我们报告一例在腹腔镜胆囊切除术中继发于门静脉、肝动脉和胆总管损伤的急性肝衰竭,需要同日紧急活体供肝移植(LDLT)。一位57岁的男性在一家外部机构接受了选择性腹腔镜胆囊切除术。在手术过程中,肝门不受控制的出血导致转为开放手术。尽管试图通过缝合来控制出血,但术后患者出现了异常的肝酶。计算机断层扫描显示右肝叶坏死和左肝叶发育不全,导致患者被转移到我们的中心。入院时,发现患者有脑病、凝血功能障碍、低血压、少尿,并伴有转氨酶水平升高。基于这些发现,紧急肝移植被认为是必要的。由于无法获得尸体器官,病人的女儿被准备作为活体供体。剖腹探查发现右肝叶坏死,左肝叶萎缩,右肝动脉和胆总管横断,右门静脉血栓形成。患者在24小时内成功接受了女儿的LDLT。在第7个月的随访中,他没有出现并发症。腹腔镜胆囊切除术中肝血管损伤可导致ALF,具有较高的死亡率。在这种情况下,LDLT可能是一种拯救生命的策略。尽早将ALF患者转诊到移植中心可以挽救生命。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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