Salhanick Marc, MacConmara Malcolm P, Pedersen Mark R, Grant Lafaine, Hwang Christine S, Parekh Justin R
Division of Vascular Surgery, Department of Surgery, the University of Texas Southwestern Medical Center, Dallas, TX 75390, United States.
Division of Surgical Transplantation, Department of Surgery, the University of Texas Southwestern Medical Center, Dallas, TX 75390, United States.
World J Hepatol. 2019 Feb 27;11(2):242-249. doi: 10.4254/wjh.v11.i2.242.
Only one case of liver transplantation for hepatic adenoma has previously been reported for patients with rupture and uncontrolled hemorrhage. We present the case of a massive ruptured hepatic adenoma with persistent hemorrhagic shock and toxic liver syndrome which resulted in a two-stage liver transplantation. This is the first case of a two-stage liver transplantation performed for a ruptured hepatic adenoma.
A 23 years old African American female with a history of pre-diabetes and oral contraceptive presented to an outside facility complaining of right-sided chest pain and emesis for one day. She was found to be in hemorrhagic shock due to a massive ruptured hepatic hepatic adenoma. She underwent repeated embolizations with interventional radiology with ongoing hemorrhage and the development of renal failure, hepatic failure, and hemodynamic instability, known as toxic liver syndrome. In the setting of uncontrolled hemorrhage and toxic liver syndrome, a hepatectomy with porto-caval anastomosis was performed with liver transplantation 15 h later. She tolerated the anhepatic stage well, and has done well over one year later.
When toxic liver syndrome is recognized, liver transplantation with or without hepatectomy should be considered before the patient becomes unstable.
此前仅有一例肝腺瘤破裂且出血无法控制的患者接受肝移植的报道。我们报告一例巨大破裂性肝腺瘤患者，伴有持续性失血性休克和中毒性肝综合征，最终接受了两阶段肝移植。这是首例因破裂性肝腺瘤而进行两阶段肝移植的病例。
一名23岁的非裔美国女性，有糖尿病前期病史且服用口服避孕药，因右侧胸痛和呕吐一天就诊于外院。她因巨大破裂性肝腺瘤而处于失血性休克状态。她接受了介入放射学的反复栓塞治疗，但仍持续出血，并出现了肾衰竭、肝衰竭和血流动力学不稳定，即中毒性肝综合征。在出血无法控制和中毒性肝综合征的情况下，先进行了肝切除及门腔静脉吻合术，15小时后进行了肝移植。她对无肝期耐受良好，一年多后情况良好。
当识别出中毒性肝综合征时，在患者病情变得不稳定之前，应考虑进行有或无肝切除术的肝移植。
