Lupaşcu Cristian, Apopei Oana, Vlad Nutu, Vasiluta Ciprian, Trofin Ana-Maria, Zabara Mihai, Vornicu Alexandra, Lupaşcu-Ursulescu Corina, Nitu Mioara, Crumpei Felicia, Braşoveanu Vladislav, Popescu Irinel
Chirurgia (Bucur). 2017 May-Jun;112(3):342-348. doi: 10.21614/chirurgia.112.3.342.
Hematoma of the graft is a life threatening complication of liver transplantation (LT) and there has been no overt conclusion in the literature about optimal management except in scarcely reported cases. It may be either intrahepatic or subcapsular, then again it may develop spontaneously or following parenchimal injuries or transhepatic percutaneous invasive manoeuvers. In this report we describe a rare case of large spontaneous graft intra- and perihepatic hematoma. A 62 year-old man underwent a whole graft orthotopic liver transplantation (OLT) for decompensated chronic liver disease due to alcoholic cirrhosis. The surgical procedure was uneventful. During the early postoperative course, routine Doppler ultrasound examination and CT-scan revealed an extrahepatic paracaval hematoma, 7 days after transplantation, which was stable and conservatively managed until the 18-th postoperative day, when rapidly expanding intraparenchimal hematoma involving the right hemiliver, several other perihepatic hematomas, significant right pleural effusion and hemorrhagic ascites were described. The patient was successfully treated conservatively (nonsurgically) with slow recovery of the liver allograft and discharged one month later in good general status.
移植肝血肿是肝移植（LT）的一种危及生命的并发症，除了少数报道的病例外，文献中对于最佳治疗方法尚无明确结论。它可能是肝内血肿或肝包膜下血肿，也可能自发形成，或在实质损伤或经肝穿刺侵入性操作后发生。在本报告中，我们描述了一例罕见的巨大自发性移植肝肝内及肝周血肿病例。一名62岁男性因酒精性肝硬化导致失代偿性慢性肝病接受了全肝原位肝移植（OLT）。手术过程顺利。术后早期，常规多普勒超声检查和CT扫描显示，移植后7天发现肝外腔静脉旁血肿，该血肿稳定，一直采取保守治疗，直到术后第18天，此时发现右半肝实质内血肿迅速扩大，还有其他几个肝周血肿、大量右侧胸腔积液和出血性腹水。该患者通过保守治疗（非手术治疗）成功治愈，移植肝缓慢恢复，一个月后出院，一般状况良好。
