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Veno‐Atrial Bypass for the Operative Treatment of Septic Gas Gangrene Secondary to Delayed Hepatic Artery Thrombosis
Author(s) -
Chan Gabriel,
Tchervenkov Jean,
Cantarovich Marcelo,
Alpert Eliot,
Deschenes Marc,
Ergina Patrick,
Metrakos Peter,
Barkun Jeffrey
Publication year - 2003
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1034/j.1600-6143.2003.00129.x
Subject(s) - medicine , sepsis , fulminant , surgery , thrombosis , artery , gangrene , liver transplantation , hepatectomy , transplantation , fulminant hepatic failure , resection
The occurrence of late hepatic artery thrombosis after orthotopic liver transplantation can result in gas gangrene of the graft. This clinical scenario has the potential to be rapidly fatal as a result of fulminant hepatic failure, sepsis and multiple‐organ‐failure syndrome. Emergency operative intervention is indicated to remove the septic source and replace the failed liver. In this report, both cases demonstrated rapid deterioration within 24 h from the onset of symptoms, in spite of maximum supportive care. Intra‐operative handling of the gangrenous graft resulted in hemodynamic instability and a technically unfeasible hepatectomy. The use of extra‐corporeal veno‐atrial bypass, by isolating the septic source, allowed for graft hepatectomy and successful re‐transplantation in the second of these reported cases.