| Management of impending or ruptured esophageal varices during anesthesia for liver transplantation: A report of 3 cases. |
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Ji Won Choi, Mi Sook Gwak, Hansu Kim, Jin kyoung Kim, Gaab Soo Kim |
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Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. gwakms@smc.samsung.co.kr |
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| Abstract |
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Portal hypertension may develop as a result of hepatic cirrhosis. One of the serious complications of portal hypertension is variceal hemorrhage. In recipients with esophageal varices, despite refinements in surgical techniques, variceal bleeding can occur during liver transplantation. The vascular isolation during cross-clamped inferior vena cava, hepatic and portal veins is associated with increases of inferior vena caval and portal venous pressures. We experienced three cases of bleeding from esophageal varices before and during living related liver transplantation and considered their management. One is bleeding during cross-clamped inferior vena cava, hepatic and portal veins. The others were carried out intraoperative endoscopy and endoscopic variceal ligation because of high risk of the esophageal variceal rupture. They were all managed successfully and recovered uneventfully. The anesthesiologists must keep in mind of the possibility of esophageal variceal bleeding during liver transplantation, and if that happens, prompt diagnosis and management must be taken. |
| Key Words:
esophageal varice; liver transplantation; variceal bleeding |
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