Gastric Volvulus Complicates the Hepatectomy for Living Donor Liver Transplantation

Reinaldo Fernandes, Marcelo Enne, Klaus Steinbruck, José Manoel Martinho, Rafael Vasconcelos, Gustavo Stoduto, Lúcio Filgueiras Pacheco-Moreira

Department of Hepatobiliary Surgery and Liver Transplantation, Bonsucesso Federal Hospital, Ministry of Health, Rio de Janeiro, Brazil.

DOI: 10.4236/ojots.2012.24005                

Abstract

Donor safety is the major concern in living donor liver transplantation (LDLT), and a constant aware of postoperative morbidity should be emphasized. Between March 2002 and May 2011 we performed 435 liver transplantations at an our center, one hundred forty eight with living donors. Among them left lobectomy or left lateral resections were conducted in 68 cases. Symptoms of gastric obstruction were recognized in 3 out of 68 patients that underwent left lateral resection (4.4%). The patients were readmitted because of severe symptoms of vomiting and abdominal pain. An upper endoscopy was performed and revealed pyloroantral obstruction due to gastric volvulus (GV). Endoscopic therapy correction was successfully performed in all patients. Reviewing the literature, one article has reported GV in 13 out of 115 donors (11.3%), all patients were submitted to a left resection. The mechanisms underlying this complication, in LDLT scenario, have not been fully elucidated. Nevertheless, clinicians should be aware of this possible association, which could make the diagnosis of GV more likely if a living donor comes back with typical symptoms.

Keywords

Living Donors; Hepatectomy; Postoperative Complications; Liver Transplantation; Gastric Volvulus

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	A. Marcos, R. A. Fisher, J. M. Ham, et al., “Right Lobe Living Donor Liver Ransplantation,” Transplantation, Vol. 68, No. 6, 1999, pp. 798-803. doi:10.1097/00007890-199909270-00012
[2]	L. F. Pacheco-Moreira, M. Enne, E. Balbi, et al., “Selection of Donors for Living Donor Liver Transplantation in a Single Center. Lesson Learned from the First 100 Patients,” Pediatric Transplantation, Vol. 10, No. 3, 2006, pp. 311-315. doi:10.1111/j.1399-3046.2005.00465.x
[3]	R. Fernandes, L. F. Pacheco-Moreira, M. Enne, et al., “Surgical Complications in 100 Donor Hepatectomies for Living Donor Liver Transplantation in a Single Brazilian Center,” Transplantation Proceedings, Vol. 42, No. 2, 2010, pp. 421-423. doi:10.1016/j.transproceed.2010.01.012
[4]	P. A. Clavien, C. A. Camargo Jr., R. Croxford, et al., “Definition and Classification of Negative Outcomes in Solid Organ Transplantation. Application in Liver Transplantation,” Annals of Surgery, Vol. 220, No. 2, 1994, pp. 109-120. doi:10.1097/00000658-199408000-00002
[5]	T. Akamatsu, N. Nakamura, K. Kiyosawa, et al., “Gastric Volvulus in Living, Related Liver Transplantation Donors and Usefulness of Endoscopic Correction,” Gastrointestinal Endoscopy, Vol. 55, No. 1, 2002, pp. 55-57. doi:10.1067/mge.2002.120388
[6]	M. Enne, L. F. Pacheco-Moreira, A. Cerqueira, et al., “Liver Transplantation with Monosegment from a Living Donor,” Pediatric Transplantation, Vol. 8, No. 2, 2004, pp. 189-191. doi:10.1046/j.1399-3046.2003.00140.x