Internal hernia of the small bowel around infrarenal arterial conduits after liver transplantation

Seigo Nishida, Antonio G. Pinna, Jose R. Nery, David Levi, Tomoaki Kato, Juan Madariaga, Andreas G. Tzakis

Research output: Contribution to journalArticle

16 Scopus citations

Abstract

Internal hernia of the small bowel is an uncommon but fatal complication of liver transplantation. The placement of infrarenal arterial conduits for arterial revascularization is an important technique for arterial reconstruction after liver transplantation. We report three cases of internal hernia with volvulus of the small bowel caused by the use of infrarenal arterial conduits. We reviewed the records of 1066 consecutive patients who underwent orthotopic liver transplantation between June 1994 and April 2000 at the University of Miami. In 271 of these patients, grafts were revascularized by anastomosing the donor iliac artery to the infrarenal aorta (an infrarenal arterial conduit). Two patients died after the surgery. One patient died of multiple organ failure because of sepsis 1 month after the surgery that involved reduction of the internal hernia and biliary reconstruction. Another patient died of multiple organ failure because of sepsis 8 days after the surgery that involved reduction of the internal hernia and adhesiolysis. One patient survived after the surgery that involved thrombectomy of the arterial graft and reduction of the internal hernia. Although there was ischemic damage to the liver after the surgery, the patient recovered. However, he died of liver failure because of recurrent infection with the hepatitis C virus 18 months after the surgery. Transplant surgeons should be aware that this complication causes not only bowel obstruction but also hepatic arterial thrombosis and ischemic liver damage. In order to prevent this complication, the arterial conduit should be retroperitonealized at the time of transplantation.

Original languageEnglish (US)
Pages (from-to)334-338
Number of pages5
JournalClinical Transplantation
Volume16
Issue number5
DOIs
StatePublished - Oct 1 2002

Keywords

  • Biliary complication
  • Hepatic artery thrombosis
  • Retroperitonealization
  • Small bowel obstruction

ASJC Scopus subject areas

  • Transplantation
  • Immunology

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    Nishida, S., Pinna, A. G., Nery, J. R., Levi, D., Kato, T., Madariaga, J., & Tzakis, A. G. (2002). Internal hernia of the small bowel around infrarenal arterial conduits after liver transplantation. Clinical Transplantation, 16(5), 334-338. https://doi.org/10.1034/j.1399-0012.2002.01149.x