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Application of resuscitative endovascular balloon occlusion in post-transplant mycotic hepatic artery pseudoaneurysm rupture in the setting of Aspergillus Constellatus bacteremia

Annals of Hepato-Biliary-Pancreatic Surgery 2021년 25권 1호 p.126 ~ 131
Stephenson Krista, Kalkwarf Kyle, Giorgakis Emmanouil,
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 ( Stephenson Krista ) - UAMS Medical Center Department of Surgery
 ( Kalkwarf Kyle ) - UAMS Medical Center Department of Surgery
 ( Giorgakis Emmanouil ) - UAMS Medical Center Department of Surgery

Abstract


Hepatic artery pseudoaneurysm (HAP) is a rare, highly morbid and frequently fatal complication of liver transplantation. Most are a mycotic mediated weakness of the arterial wall, with associated bacterial or fungal infection of ascitic fluid. As it is usually asymptomatic prior to rupture, the majority present in acute hemorrhagic shock and dire extremis. Resuscitative endovascular balloon occlusion (REBOA) was initially developed for the management of noncompressible hemorrhagic shock in trauma; however, remains underutilized and understudied in the non-trauma setting. We present the case of a mycotic hepatic artery pseudoaneurysm rupture due to Streptococcus constellatus and Klebsiella pneumoniae post directed donor orthoptic liver transplant, in which REBOA was employed in the setting of impending exsanguination as a bridge to definitive surgical intervention. Although this patient passed away of multiorgan system failure prior to re-transplant, this case demonstrates the importance of a heightened suspicion of this devastating complication, especially in the setting of bilioenteric reconstruction and perihepatic fluid collection, as well as the benefit of utilizing resuscitative techniques such as REBOA prior to definitive surgical or endovascular therapy to mitigate the high morbidity and mortality of this condition.

키워드

Hepatic artery pseudoaneurysm; Streptococcus constellatus; REBOA; Resuscitative endovascular balloon occlusion; Liver transplantation

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