Splenic and partial hepatic necrosis after vascular occlusion

Area of Science:

• Nuclear medicine
• Radiology
• Vascular surgery

Background:

• A 74-year-old female patient underwent surgical repair of an aortoduodenal fistula and axillofemoral bypass grafting.
• These procedures necessitated temporary vascular occlusion, a known risk factor for organ ischemia.

Observation:

• The patient exhibited deteriorating hepatic function tests post-operatively.
• Technetium-99m sulfur colloid scintigraphy demonstrated abnormal findings, including renal uptake, bone marrow and lung deposition, and a significant lateral hepatic defect.
• The spleen was not visualized on imaging, and CT confirmed hepatic necrosis.

Findings:

• Renal radiocolloid uptake suggested disseminated intravascular coagulation.
• Extensive radiocolloid in the bone marrow and lungs indicated severe hepatic dysfunction and necrosis.
• Absence of splenic visualization and hepatic defect confirmed splenic and hepatic necrosis, likely secondary to vascular clamping.

Implications:

• This case underscores the potential for severe hepatic and splenic necrosis following temporary vascular occlusion during complex vascular surgeries.
• Tc-99m sulfur colloid scintigraphy can be a valuable tool in diagnosing and assessing the extent of organ damage in such scenarios.
• Early recognition of these complications is crucial for appropriate patient management and prognosis.