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Petersen's hernia after living donor liver transplantation


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タイトル: Petersen's hernia after living donor liver transplantation
著者: Sakamoto, Sodai 著作を一覧する
Goto, Ryoichi 著作を一覧する
Kawamura, Norio 著作を一覧する
Koshizuka, Yasuyuki 著作を一覧する
Watanabe, Masaaki 著作を一覧する
Ota, Minoru 著作を一覧する
Suzuki, Tomomi 著作を一覧する
Abo, Daisuke 著作を一覧する
Yamashita, Kenichiro 著作を一覧する
Kamiyama, Toshiya 著作を一覧する
Taketomi, Akinobu 著作を一覧する
Shimamura, Tsuyoshi 著作を一覧する
キーワード: Living donor liver transplantation
Petersen's hernia
Biliary reconstruction
発行日: 2017年 8月23日
出版者: Springer
誌名: Surgical case reports
巻: 3
開始ページ: 89
出版社 DOI: 10.1186/s40792-017-0364-5
抄録: Background: Hepaticojejunostomy may be used for biliary reconstruction in certain cases of liver transplantation. In this occasion, Roux-en-Y biliary reconstruction is predominantly performed. Petersen's hernia is an internal hernia that can occur after Roux-en-Y reconstruction, and it may lead to extensive ischemic changes affecting incarcerated portions of the small bowel or Roux limb resulting in severe complications with a poor prognosis. Case presentation: The present case was a 44-year-old male who underwent living donor liver transplantation (LDLT) for familial amyloid polyneuropathy and in whom biliary reconstruction was performed with Roux-en-Y hepaticojejunostomy. Two years after liver transplantation, symptomatic bowel strangulation was diagnosed by CT examination and emergent surgery was performed accordingly. On exploration, an ischemic limb associated with Petersen's hernia was observed. Although repositioning of the incarcerated bowel loop gradually improved the color of the limb, the limb failed to completely recover to a normal color. To allow accurate evaluation for the viability of the limb, we decided to perform a second-look operation after 48 h. On re-exploration, the surface of the limb remained a dark color; however, intraoperative endoscopic findings revealed only partial necrosis of the mucosa. Next, we resected the portion of ischemic damaged limb only following side-to-side jejunojejunostomy. Consequently, redoing of biliary reconstruction could be avoided and the original hepaticojejunostomy site was preserved. Although the stricture of the remnant Roux limb occurred 1 month thereafter, it was successfully managed by balloon dilation via percutaneous transhepatic biliary drainage route. Conclusions: The occurrence of Petersen's hernia should always be considered in cases of liver transplantation with Roux-en-Y biliary reconstruction. On the basis of an accurate assessment of the extent of jejunal limb injury, reanastomosis of the hepaticojejunostomy, a potentially high-risk surgical procedure, can be avoided in emergent situations.
資料タイプ: article
出現コレクション:雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

提供者: 嶋村 剛


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