Anesth Pain Med.  2017 Apr;12(2):165-168. 10.17085/apm.2017.12.2.165.

Rectal ectopic variceal bleeding during liver transplantation: A case report

• Kim YH
• Lee YS
• Yoon YS
• Hong S
• Kim WY
• Kim JH
• Park YC

• KMID: 2379739
• DOI: http://doi.org/10.17085/apm.2017.12.2.165

Abstract

Portal hypertension can lead to development of new veins, called collateral vessels in the esophagus, stomach, abdominal wall, rectum and so on. In particular, collateral vessels located in other site than the gastroesophageal region are defined as ectopic varices. These varices are fragile and can rupture easily, resulting in a large amount of blood loss that may become serious and occasionally result in death. We experienced a case of massive rectal variceal bleeding after cross-clamping of the inferior vena cava and hepatic portal vein during the living donor liver transplantation in patients who had no history of rectal variceal bleeding. Our case suggests that acute intraoperative hemorrhage from an ectopic varix should be a consideration before liver transplantation.

Keyword

Ectopic varices bleeding; End-stage liver disease; Liver transplantation

MeSH Terms

Abdominal Wall
Esophageal and Gastric Varices*
Esophagus
Hemorrhage
Humans
Hypertension, Portal
Liver Transplantation*
Liver*
Living Donors
Portal Vein
Rectum
Rupture
Stomach
Varicose Veins
Veins
Vena Cava, Inferior

Figure

• 

  Fig. 1 Computed tomography (CT) scan demonstrating prominent rectal varices in a patient with cirrhosis with rectal varices. The open arrow indicates the rectal varices. (A) Abdomen CT coronal image. (B) Abdomen CT sagittal iamge.

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