Vianna Rodrigo, Giovanardi Rafael O, Fridell Jonathan A, Tector Alfred Joseph
Division of Transplantation, Department of Surgery, Indiana University, Indianapolis, IN 46202-5149, USA.
Transplantation. 2005 Aug 27;80(4):534-5. doi: 10.1097/01.tp.0000168344.16547.da.
Portal vein thrombosis is the most common cause of portal hypertension in noncirrhotic patients. Variceal bleeding is difficult to treat in these patients, especially those with prehepatic diffuse portal mesenteric thrombosis. In a patient with refractory esophagogastroduodenal variceal bleeding as a result of diffuse portomesenteric thrombosis and portal hypertension, life-threatening bleeding was unresponsive to endoscopic therapy and other surgical procedures. A multivisceral transplant was performed. It was curative and also lifesaving. There is only one report in the literature mentioning multivisceral transplantation for a patient with life-threatening esophagogastroduodenal bleeding; however that patient had protein C deficiency. Our patient had normal liver and intestinal function tests and no signs of hypercoagulable disease. We believe that multivisceral transplantation should be considered as a treatment option for patients with diffuse mesenteric thrombosis, even in the absence of liver and intestinal failure, when other treatment options for variceal bleeding have failed, particularly in a younger patient with a relatively good nutritional status before transplantation.
门静脉血栓形成是无肝硬化患者门静脉高压最常见的原因。这些患者的曲张静脉出血难以治疗，尤其是那些患有肝前性弥漫性门静脉肠系膜血栓形成的患者。在一名因弥漫性门静脉肠系膜血栓形成和门静脉高压导致难治性食管胃十二指肠曲张静脉出血的患者中，危及生命的出血对内镜治疗和其他外科手术均无反应。于是进行了多脏器移植。该手术具有治愈性且挽救了患者生命。文献中仅有一篇报道提及对一名患有危及生命的食管胃十二指肠出血的患者进行多脏器移植；然而，该患者存在蛋白C缺乏症。我们的患者肝功能和肠功能检查正常，且无高凝疾病迹象。我们认为，对于弥漫性肠系膜血栓形成的患者，即使没有肝和肠功能衰竭，当曲张静脉出血的其他治疗选择均失败时，尤其是对于移植前营养状况相对良好的年轻患者，多脏器移植应被视为一种治疗选择。
