Abstract:
t We herein describe two cases of liver transplantation
with portal vein thrombosis. In both cases, a tear
advancing to the retropancreatic area occurred during
portal vein thrombectomy. Hemorrhage from the limited
visibility retropancreatic area made it impossible to stop
the bleeding by clamping or direct suturing, and the
clamping and suturing efforts actually increased the hemorrhage,
possibly due to the damaged and thin portal vein
wall. First, finger compression over the retropancreatic area
was employed to stop the bleeding, then a Foley urinary
catheter was introduced into the portal vein under the finger.
The balloon of the catheter was inflated with 8 cc of
normal saline, and the finger was released. The bleeding
was stopped temporarily, and two different venous conduits
were sutured to the trimmed portal vein stump in a
bloodless surgical area. The venous conduits were easily
controlled with vascular clamps after deflating the balloon
catheters, and implantation of the liver was then done in a
standard manner. Balloon tamponade can be a lifesaving
technique that can temporarily stop a hemorrhage to allow
for definitive repair in cases of retropancreatic portal vein
hemorrhage.