Abdel Wahab Mohamed, Shehta Ahmed, Adly Reham, Elshoubary Mohamed, Salah Tarek, Yassen Amr M, Elmorshedi Mohamed, Emara Moataz M, Abdelkhalek Mostafa, Elsedeiq Mahmoud, Shiha Usama, Elghawalby Ahmed N, Eldesoky Mohamed, Monier Ahmed, Said Rami
Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt.
Department of Surgery, Gastrointestinal Surgery Center, College of Medicine, Mansoura University, Egypt.
Int J Surg Case Rep. 2018;49:158-162. doi: 10.1016/j.ijscr.2018.06.023. Epub 2018 Jun 28.
Biliary reconstruction is a cornerstone of living-donor liver transplantation (LDLT). The routine uses of trans-anastomotic biliary catheters in biliary reconstruction had been a controversial issue. We describe a rare complication related to the use of trans-anastomotic biliary catheter after LDLT. In this case, intestinal obstruction occurred early after LDLT due to internal herniation of the small bowel around trans-anastomotic biliary catheter.
A 42 years male patient with end stage liver disease underwent LDLT utilizing a right hemi-liver graft. Biliary reconstruction was done by single duct-to-duct anastomosis over trans-anastomotic biliary catheter. The patient was doing well apart from early postoperative ascites that was managed medically. Three weeks after surgery, the patient developed severe agonizing central abdominal pain not responding to anti-spasmodics and analgesics. The decision was to proceed for surgical exploration. Exploration revealed internal herniation of the small bowel loops around the trans-anastomotic biliary catheter without strangulation. Reduction of the internal hernia was done by releasing the fixation of the biliary catheter from the anterior abdominal wall. Small bowel resection was not required. The patient had smooth postoperative course and was discharged 10 days after surgery.
Awareness regarding this rare complication plus early surgical intervention can prevent the development of postoperative morbidity and mortality. To the best of our knowledge this is the first report to describe such are complication after LDLT.
We report the first case of internal herniation of small bowel around biliary catheter early after LDLT.
胆管重建是活体肝移植（LDLT）的基石。在胆管重建中常规使用经吻合口胆管导管一直是一个有争议的问题。我们描述了一例与LDLT后使用经吻合口胆管导管相关的罕见并发症。在该病例中，LDLT术后早期因小肠围绕经吻合口胆管导管发生内疝而出现肠梗阻。
一名42岁的终末期肝病男性患者接受了右半肝移植的LDLT手术。胆管重建通过在经吻合口胆管导管上进行单管对管吻合完成。除术后早期经药物治疗的腹水外，患者情况良好。术后三周，患者出现严重的中上腹剧痛，解痉药和镇痛药均无效。决定进行手术探查。探查发现小肠袢围绕经吻合口胆管导管发生内疝，但无绞窄。通过松开胆管导管与前腹壁的固定来复位内疝。无需进行小肠切除。患者术后恢复顺利，术后10天出院。
认识到这种罕见并发症并尽早进行手术干预可预防术后发病和死亡。据我们所知，这是第一例描述LDLT后出现这种并发症的报告。
我们报告了第一例LDLT术后早期小肠围绕胆管导管发生内疝的病例。
