Simultaneous or sequential gastrectomy in pediatric liver transplant recipients

Area of Science:

• Pediatric Surgery
• Hepatology
• Gastroenterology

Background:

• The combined procedure of liver transplantation (LT) and gastrectomy is infrequently documented, particularly in pediatric cases.
• Existing literature reports limited associations between gastrectomy and LT in children, necessitating further case studies.

Observation:

• This report presents three pediatric patients who underwent LT and subsequently required concomitant or sequential partial gastrectomy for diverse medical reasons.
• Case 1 involved a partial gastrectomy during LT due to duodenal injury and prior portoenterostomy. Case 2 required gastrectomy during retransplantation for a perforated gastric ulcer. Case 3 underwent gastrectomy five years post-LT for gastric outlet obstruction attributed to eosinophilic gastritis.

Findings:

• The association between pediatric liver transplantation and gastrectomy is exceptionally rare.
• Successful management involved varied reconstructive techniques, including intestinal loops for bilio-enteric anastomosis and Roux-en-Y reconstruction.
• Histopathological findings in one case indicated eosinophilic gastritis as the cause of obstruction.

Implications:

• Understanding prior surgical techniques is crucial for managing patients undergoing LT and gastrectomy.
• Further research is needed to evaluate the long-term outcomes of different gastric reconstruction methods in pediatric LT recipients.
• This case series underscores the complexity and rarity of combined LT and gastrectomy in children, emphasizing tailored surgical approaches.