Upper GI bleeding in a post-liver transplant patient. Hepatic artery pseudoaneurysm.
Upper GI bleeding in a post-liver transplant patient. Hepatic artery pseudoaneurysm.
复制标题
肝移植后患者的上消化道出血。
DOI：
10.1053/j.gastro.2011.12.014
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发表时间：
2012
期刊：
影响因子：
29.4
通讯作者：
Sharma,Pratima
中科院分区：
文献类型：
--
作者：
Prabhu,Anoop;Dasika,NarasimhamL;Sharma,Pratima
一名45岁的男子提出了大量便血和随后呕血急诊室。他的病史值得注意的是α-1抗胰蛋白酶缺乏症，最终肝衰竭。他在9个月前接受了原位肝移植，并发缺血性胆管病伴复发性胆管炎，需要连续经皮胆管造影换管。他在就诊前2个月接受了再次移植，这次的术后病程相对简单。患者未服用阿司匹林或任何非甾体类抗炎药。在该报告中，患者无发热，但血流动力学不稳定，血压为82/60 mmHg，心率为110 bpm。鼻胃灌洗返回鲜红色血液和凝块。实验室检查值如下：白色血细胞计数，8300/μL（中性粒细胞，82%）;血红蛋白，8.2 g/dL;血小板计数，192，000/mm 3;血尿素氮，24 mg/dL;肌酐，1.0 mg/dL;凝血酶原时间，12.4秒;国际标准化比值，1.2。在入院和干预之间，患者总共需要输注12 U浓缩红细胞以提供血流动力学支持。上消化道内窥镜检查显示食道正常。胃里有大量血块，但没有活动性出血的部位。十二指肠检查显示从乏特壶腹流出的粘附血块（图A）。患者转诊至介入放射科进行内脏血管造影（图B）。
A 45-year-old man presented to the emergency room with large-volume hematochezia and subsequent hematemesis. His medical history is notable for alpha-1 antitrypsin deficiency with eventual liver failure. He underwent orthotopic liver transplantation 9 months prior, which was complicated by ischemic cholangiopathy with recurrent cholangitis and need for serial percutaneous cholangiogram tube exchanges. He underwent retransplantation 2 months before presentation, this time with a relatively uncomplicated postoperative course. The patient was not on aspirin or any nonsteroidal anti-inflammatory drugs. On this presentation, he was afebrile but hemodynamically unstable with a blood pressure of 82/60 mmHg and a heart rate of 110 bpm. Nasogastric lavage returned bright red blood with clot. Laboratory values were as follows: White blood cell count, 8300/μL (neutrophils, 82%); hemoglobin, 8.2 g/dL; platelet count, 192,000/mm3; blood urea nitrogen, 24 mg/dL; creatinine, 1.0 mg/dL; prothrombin time, 12.4 seconds; and International Normalized Ratio, 1.2. Between admission and intervention, the patient required a total transfusion of 12 U of packed red blood cells for hemodynamic support.Upper gastrointestinal endoscopy revealed a normal esophagus. The stomach contained a large amount of blood clot, but no site of active bleeding. Examination of the duodenum showed an adherent blood clot emanating from the ampulla of Vater (Figure A). The patient was referred to interventional radiology for visceral angiography (Figure B).