Hepatic venous outflow obstruction after living donor liver transplantation managed with ectopic placement of a foley catheter: A case report

AbstractIntroductionThe early hepatic venous outflow obstruction (HVOO) is a rare but serious complication after liver transplantation, which may result in graft loss. We report a case of early HVOO after living donor liver transplantation, which was managed by ectopic placement of foley catheter.PresentationA 51 years old male patient with end stage liver disease received a right hemi-liver graft. On the first postoperative day the patient developed impairment of the liver functions. Doppler ultrasound (US) showed absence of blood flow in the right hepatic vein without thrombosis. The decision was to re-explore the patient, which showed torsion of the graft upward and to the right side causing HVOO. This was managed by ectopic placement of a foley catheter between the graft and the diaphragm and the chest wall. Gradual deflation of the catheter was gradually done guided by Doppler US and the patient was discharged without complications.DiscussionMechanical HVOO results from kinking or twisting of the venous anastomosis due to anatomical mismatch between the graft and the recipient abdomen. It should be managed surgically by repositioning of the graft or redo of venous anastomosis. Several ideas had been suggested for repositioning and fixation of the graft by the use of Sengstaken–Blakemore tubes, tissue expanders, and surgical glove expander.ConclusionWe report the use of foley catheter to temporary fix the graft and correct the HVOO. It is a simple and safe way, and could be easily monitored and removed under Doppler US without any complications

Intestinal and peritoneal lymphoma complicating Chron’s disease

Abstract Background Crohn’s disease is an inflammatory bowel disease which mostly affects the small intestine. It has a variable clinical course, with alternating attacks of exacerbation and remission. In the last decades, the incidence of Crohn’s disease has been increasing, so imaging of those cases has become more important. Case presentation We report a case of a male patient who was treated for Chron’s disease in the past three years and presented with abdominal pain. Post-contrast CT abdomen and pelvis was done revealing soft tissue thickening of intestinal walls in a skip fashion with multiple peritoneal deposits. The case was pathologically proven to be anaplastic large cell lymphoma on top of Chron’s disease. Conclusions The cause of the association between Crohn's disease and lymphoma is still elucidated. Radiologists should be aware that Chron’s disease can be complicated by intestinal and peritoneal lymphoma and should suspect the presence of lymphoma on top of Chron’s disease if there is wall thickening of soft tissue attenuation affecting the small bowels in a skipping manner following the areas previously affected by Chron’s disease