Ischemic colitis with small-vessel occlusion, simultaneous total colectomy and liver transplantation: A case report.

Abstract

Background: The colon is the hollow viscera that proportionally has the lowest vascular supply and is more predisposed to ischemic colitis. In the context of end-stage liver disease, various components may explain this group's greater predisposition to colonic ischemic events. Furthermore, portal hypertension generates a process of coagulopathy, impairing local vascularization. This case report describes a case of ischemic colitis with small-vessel occlusion found during liver transplantation in a patient with decompensated end-stage liver disease.

Case summary: A 64-year-old man with liver cirrhosis due to non-alcoholic steatohepatitis and hepatocellular carcinoma. The patient underwent liver transplantation due to hepatic decompensation. The donor was a 53-year-old man who had died of a hemorrhagic stroke. Cavitary examination revealed diffuse ischemic colitis with significant distention and necrosis. Due to the condition of the colon, a subtotal colectomy was performed. Liver transplantation with warm ischemia time of 35 minutes, cold ischemia of 6 hours 30 minutes and total ischemia time of 7 hours 5 minutes. The patient improved clinically with oral tract function and physiotherapy, but unfortunately, he developed a bloodstream infection, a new septic shock and died six months after surgery.

Conclusion: Simultaneous total colectomy and orthotopic liver transplantation represent a rare situation. Ischemic events have a high mortality rate in the general population and are particularly important in cirrhotic patients.