Liver dysfunction due to “portal hyperperfusion” after mesenteric revascularization

The post-operative course after mesenteric revascularization for chronic mesenteric ischemia is associated with significant morbidity (5%–30%) and mortality (5%–12%), since many of these patients develop significant liver dysfunction, with cholestasis and transaminitis, and a vitamin-K resistant coagulopathy with a fall in platelet count. An elderly male underwent mesenteric revascularization and developed ascites, jaundice, transaminitis and coagulopathy with thrombocytopenia; which gradually recovered over 7–10 days. The post-operative findings are remarkably similar to that seen in portal hyperperfusion, or small for size syndrome (SFSS) after living donor liver transplantation. Mesenteric revascularization results in improved blood blow through the splanchnic circulation, and results in an increased portal blood flow after repair. The portal hyperperfusion may explain the manifestations seen after mesenteric revascularization, including the liver dysfunction, coagulopathy and in extreme cases renal and pulmonary dysfunction.