Living-Related Liver Retransplantation in a Child: When it Seems Impossible (A Clinical Case)
https://doi.org/10.21292/2078-5658-2022-19-4-97-102
Abstract
The objective: to show the possibility of anesthesia during liver retransplantation in a child in the absence of adequate vascular access.
A clinical case of liver retransplantation in a 10-year-old patient with liver transplant dysfunction and acquired thrombophilia is considered. In 2011, the child underwent Kasai portoenterostomy, and in 2012, living-related transplantation of the left lateral liver bisegment from a related donor was performed due to liver cirrhosis as an outcome of biliary atresia. Also, the child had multiple surgical interventions due to perforations of the small intestine with underlying segmental venous mesenteric thrombosis. In the long term after the transplantation, irreversible transplant dysfunction developed with manifestations and worsening of hepatocellular insufficiency, encephalopathy, as well as recurrent bleeding from varicose veins of the esophagus and cardiac orifice. The clinical situation was complicated by the lack of adequate vascular access due to total thrombosis of the venous system, thrombosis of the superior and inferior vena cava. The only possible option for ensuring adequate venous access was the implantation of a tunneled catheter into the right atrium of the right atrium for prolonged standing in conditions of single-lung ventilation through right-sided thoracotomy.
About the Authors
D. I. Novikov
Russian Surgery Research Center Named after B. V. Petrovsky
Russian Federation
Russian Federation
Denis I. Novikov, Anesthesiologist and Emergency Physician of Anesthesiology and Intensive Care Unit no. 1 of the Russian Federation State Research Center
2, Abrikosovsky Lane, Moscow, 119991
A. Yu. Zaitsev
Russian Surgery Research Center Named after B. V. Petrovsky; Sechenov First Moscow State Medical University (Sechenov University),
Russian Federation
Russian Federation
Andrey Yu. Zaitsev, Doctor of Medical Sciences, Head, Chief Researcher of Anesthesiology and Intensive Care Department no. 1
of the Russian Federation State Research Center
2, Abrikosovsky Lane, Moscow, 119991
A. V. Filin
Russian Surgery Research Center Named after B. V. Petrovsky
Russian Federation
Russian Federation
Andrey V. Filin, Doctor of Medical Sciences, Head of Liver Transplantation Department of the Russian Federation State Research Center
2, Abrikosovsky Lane, Moscow, 119991
E. R. Charchyan
Russian Surgery Research Center Named after B. V. Petrovsky
Russian Federation
Russian Federation
Eduard R. Charchyan, Doctor of Medical Sciences, Professor, Correspondent Member of RAS, Head of Cardiosurgery Department of the Russian Federation State Research Center
2, Abrikosovsky Lane, Moscow, 119991
A. V. Metelin
Russian Surgery Research Center Named after B. V. Petrovsky
Russian Federation
Russian Federation
Aleksey V. Metelin, Surgeon, Junior Researcher of Liver Transplantation Department of the Russian Federation State Research Center
2, Abrikosovsky Lane, Moscow, 119991
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Review
For citations:
Novikov D.I., Zaitsev A.Yu., Filin A.V., Charchyan E.R., Metelin A.V. Living-Related Liver Retransplantation in a Child: When it Seems Impossible (A Clinical Case). Messenger of ANESTHESIOLOGY AND RESUSCITATION. 2022;19(4):97-102. (In Russ.) https://doi.org/10.21292/2078-5658-2022-19-4-97-102
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