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Published on: October 29, 2014
Ischemic colitis with small-vessel occlusion, simultaneous total colectomy and liver transplantation: A case report
Leonardo Yuri Kasputis Zanini1,2, Fabiana Roberto Lima3,4, Michel Ribeiro Fernandes2
1Department of Surgery, Federal University of São Paulo, São Paulo 04023-062, Brazil.
Insights
This case report details ischemic colitis with small-vessel occlusion in a liver transplant patient with end-stage liver disease. Simultaneous colectomy and liver transplant highlight the high mortality of ischemic events in cirrhotic patients.
Area of Science:
- Gastroenterology
- Hepatology
- Transplant Surgery
Background:
- End-stage liver disease (ESLD) increases predisposition to colonic ischemic events.
- Portal hypertension in ESLD can cause coagulopathy, impairing colonic vascularization.
- Colonic vascular supply is proportionally low, increasing susceptibility to ischemia.
Observation:
- A 64-year-old male with liver cirrhosis underwent liver transplantation.
- Diffuse ischemic colitis with necrosis was found during surgery.
- A subtotal colectomy was performed concurrently with the liver transplant.
Findings:
- The patient experienced a rare simultaneous total colectomy and orthotopic liver transplantation.
- Ischemic colitis was attributed to small-vessel occlusion.
- Post-transplant complications included bloodstream infection and septic shock.
Implications:
- Ischemic colitis poses a significant risk in patients with end-stage liver disease undergoing transplantation.
- Combined colectomy and liver transplantation is an uncommon procedure.
- Prompt recognition and management of colonic ischemia are critical in cirrhotic patients.
Background:
The colon is the hollow viscera that proportionally has the lowest vascular supply and is more predisposed to ischemic colitis. In the context of end-stage liver disease, various components may explain this group's greater predisposition to colonic ischemic events. Furthermore, portal hypertension generates a process of coagulopathy, impairing local vascularization. This case report describes a case of ischemic colitis with small-vessel occlusion found during liver transplantation in a patient with decompensated end-stage liver disease.
Case Summary:
A 64-year-old man with liver cirrhosis due to non-alcoholic steatohepatitis and hepatocellular carcinoma. The patient underwent liver transplantation due to hepatic decompensation. The donor was a 53-year-old man who had died of a hemorrhagic stroke. Cavitary examination revealed diffuse ischemic colitis with significant distention and necrosis. Due to the condition of the colon, a subtotal colectomy was performed. Liver transplantation with warm ischemia time of 35 minutes, cold ischemia of 6 hours 30 minutes and total ischemia time of 7 hours 5 minutes. The patient improved clinically with oral tract function and physiotherapy, but unfortunately, he developed a bloodstream infection, a new septic shock and died six months after surgery.
Conclusion:
Simultaneous total colectomy and orthotopic liver transplantation represent a rare situation. Ischemic events have a high mortality rate in the general population and are particularly important in cirrhotic patients.
