Title of article :
Massive Subcutaneous Emphysema, Pneumoperitoneum, Pneumoretroperitoneum, and Pneumoscrotum following Endoscopic Retrograde Cholangiopancreatography in a Living Liver Donor
Author/Authors :
Akbulut, S. Department of Surgery and Liver Transplant Institute- Inonu University Faculty of Medicine, Malatya, Turkey , Isik, B. Department of Surgery and Liver Transplant Institute- Inonu University Faculty of Medicine, Malatya, Turkey , Karipkiz, Y. Department of Nursing Service- Inonu University Faculty of Medicine, Malatya, Turkey , Yilmaz, S. Department of Surgery and Liver Transplant Institute- Inonu University Faculty of Medicine, Malatya, Turkey
Abstract :
Despite having many advantages, living donor liver transplantation has not been adopted by
western countries due to risk of nearly life-threatening complications after living donor hepatectomy
(LDH). Herein, we aimed at presenting the management of a 19-year-old patient who
suffered life-threatening complications after right lobe LDH. A multiple detector computed
tomography (MDCT) revealed a bilioma at the cut surface of the remnant liver, for which a
transhepatic drainage catheter was placed. Endoscopic retrograde cholangiopancreatography
(ERCP) performed to decompress biliary tract, but the biliary tract could not be cannulized due
to post-precut bleeding. On the next day, extensive crepitation was detected and MDCT showed
subcutaneous emphysema, pneumoperitoneum, pneumoretroperitoneum, and pneumoscrotum
(ERCP-related duodenal perforation?). However, the patient showed significant deterioration
of physical examination findings, fever, and infectious parameters, and therefore was taken
to the operating room. Kocher maneuver revealed no apparent duodenal perforation. Then, a
2-mm bile duct was found open at the caudate lobe, through which bile leaked. Then, common
bile duct exploration and T-tube placement were performed, followed by suture closure of the
bile orifice at the caudate lobe. Massive air previously identified completely disappeared one
week after the operation.
Keywords :
Duodenal perforation , ERCP-related complication , Living donor hepatectomy , Biliary complication
Journal title :
Astroparticle Physics