Hepatic venous outflow obstruction after living donor liver transplantation managed with ectopic placement of a foley catheter: A case report

• Hepatic venous outflow obstruction is a rare serious complication after liver transplantation.
• Hepatic venous outflow obstruction may result in graft loss and recipient death.
• We report the use of the foley catheter to temporary fix the graft and correct the hepatic venous outflow obstruction.
• It is a simple, cheap and safe device to correct the hepatic venous outflow obstruction.
• It could be easily monitored and removed under Doppler US without any device related complications.

IntroductionThe early hepatic venous outflow obstruction (HVOO) is a rare but serious complication after liver transplantation, which may result in graft loss. We report a case of early HVOO after living donor liver transplantation, which was managed by ectopic placement of foley catheter.PresentationA 51 years old male patient with end stage liver disease received a right hemi-liver graft. On the first postoperative day the patient developed impairment of the liver functions. Doppler ultrasound (US) showed absence of blood flow in the right hepatic vein without thrombosis. The decision was to re-explore the patient, which showed torsion of the graft upward and to the right side causing HVOO. This was managed by ectopic placement of a foley catheter between the graft and the diaphragm and the chest wall. Gradual deflation of the catheter was gradually done guided by Doppler US and the patient was discharged without complications.DiscussionMechanical HVOO results from kinking or twisting of the venous anastomosis due to anatomical mismatch between the graft and the recipient abdomen. It should be managed surgically by repositioning of the graft or redo of venous anastomosis. Several ideas had been suggested for repositioning and fixation of the graft by the use of Sengstaken–Blakemore tubes, tissue expanders, and surgical glove expander.ConclusionWe report the use of foley catheter to temporary fix the graft and correct the HVOO. It is a simple and safe way, and could be easily monitored and removed under Doppler US without any complications.