Liver transplantation after complete hepatic artery avulsion secondary to blunt abdominal trauma

Abstract

Background: Hepatic artery avulsion secondary to blunt abdominal trauma is a rare cause of massive hemoperitoneum. Ischemic cholangiopathy it is a possible complication secondary to its ligation. Methods: We report the case of a trauma patient with ischemic cholangiopathy secondary to hepatic artery ligation who required liver transplant (LT). Results: A 37-year-old man was admitted to the emergency room after falling from a third-floor flat. During surgical exploration, a massive hemoperitoneum secondary to hepatic artery avulsion was observed. Reconstruction of the artery could not be achieved so it was ligated. He was admitted to ICU, improving progressively of his hemodynamic instability and ischemic hepatic failure. MRI, 34 days after surgery, showed diffuse ischemic cholangiopathy. After severe repeated cholangitis he was included for LT that was performed 70 days after surgery using a classic technique due to its huge liver volume (4200 gr). During immediate postoperative period he was reoperated four times due to hemoperitoneum and necrohemorrhagic pancreatitis. On day 36th after LT, he developed a nonsurgical intracranial hemorrhage, dying 2 days after. Conclusion: Diffuse ischemic cholangiopathy secondary to hepatic artery lesion is an uncommon indication of LT. Traumatized patients with vascular lesions should be transferred to a specialized center.