SENGSTAKEN-BLAKEMORE tube can prevent whole liver twisting the right hepatic fossa improving venous outflow post-orthotopic liver transplantation

Abstract

Introduction: Reduced-size liver transplantation in combination with an unusual situation poses an increased risk for venous outflow obstruction. Reduced-size liver transplantation using ex-vivo graft reduction or splitting has become standard procedure in children, with some of these cases described in literature after the successful management use of Sengstaken-Blakemore, although used in orthotopic whole liver transplantation (OLT) has never been described. The aim was to report the successful management of acute venous obstruction after OLT by using a Sengstaken-Blakemore tube within the hepatic fossa in a 51-year-old male patient. Case Report: A 51-year old male patient with hepatitis C cirrhosis and alcoholism, C Child-Pugh, 24 MELD score was submitted to OLT by using the piggy-back technique. The donor and recipient body-weight ratio was 1.38 (65/90kg). The liver recipient weight was 1,152g and the donor liver was 992g. After reperfusion time, the patient showed a venous outflow obstruction in supra-hepatic anastomosis with total resolution after clockwise rotation of the graft, but reduced venous outflow was observed after liver twist to the right hepatic fossa and mean arterial blood pressure (MAP) was reduced to 30 mmHg . After five attempts, a Sengstaken-Blakemore tube was inserted into the right subphrenic space and the gastric and oesophageal balloons were inflated to maintain the graft at the midline position with normalization of the MAP and venous outflow. Although data on hemodynamic measurements were maintained during the ICU period, a Doppler ultrasonography (DUS) was carried out daily to ensure that venous outflow was maintained. On 4th day, the gastric balloon was deflated; after 2 hours the oesophageal balloon was deflated and no systemic abnormality was detected. The Sengstaken-Blakemore tube with deflated balloons was removed on 5th day using slight traction. Later, DUS was carried out after it was shown that venous outflow was maintained and the liver was fixed in a hemodynamically correct position without interfering in the mechanical outflow. The patient was discharged, and he is in good condition. Conclusion: The Sengstaken -Blakemore tube is a good tool to improve liver venous outflow due to mechanical problems such as twist of the right hepatic fossa and preventing re-operations.