Within the article ¿spontaneous migration of thrombosed synthetic vascular graft to the duodenum after living-donor liver transplantation: a case-report¿, published by ahmed mohamed sultan et al, within the international journal of surgery case reports, published on march 15, 2018, the circulated results indicated the following: a (b)(6) male patient with end stage liver disease due to chronic hepatitis c virus infection underwent living donor liver transplantation utilizing a right hemi-liver graft from his son.Right hepatic vein reconstruction was done by end-to-side anastomosis between donor right hepatic vein and inferior vena cava using continuous 4/0 polypropylene sutures with venoplasty.Drainage of segment v vein was done to side of inferior vena cava using an externally supported polytetra-fluoroethylene (ptfe) synthetic vascular graft (gore-tex 6 mm in diameter) by 4/0 polypropylene sutures.Reconstruction of the portal vein was done by end-to-end anastomosis between donor right portal vein and recipient main portal vein using continuous 5/0 polypropylene sutures.Reconstruction of the hepatic artery was done by end-to-end anastomosis between donor right hepatic artery and recipient right hepatic artery using interrupted 8/0 polypropylene sutures.Doppler ultrasound (us) examination was done after completion of vascular anastomoses and at the end of operation which confirmed patency of all vascular anastomoses.Doppler us was performed daily in the first postoperative week to evaluate patency of vascular anastomoses, and twice weekly afterwards till patient discharge.The patient had smooth post-operative course, and was discharged without complications.Follow up doppler us was done regularly to confirm patency of vascular anastomoses.No vascular abnormalities were detected apart from thrombosis of segment v vein, which was detected in the fourth postoperative month.During an endoscopic retrograde cholangio-pancreatography (ercp) set that was done two and half years after transplantation, the thrombosed synthetic vascular graft was seen eroding into the first part of the duodenum.The procedure was completed and balloon dilatation of the anastomotic stricture and re-stenting was done.The patient was generally stable and the decision was to follow up the condition of the eroding synthetic vascular graft.A computed tomography was done 1 week later and showed disappearance of the synthetic vascular graft from the abdomen.Follow up endoscopy afterwards revealed a small ulcer in the first part of the duodenum at the site of the migrated synthetic vascular graft with no other abnormalities.In this report, we describe a rare case of spontaneous migration of thrombosed synthetic vascular graft after living donor liver transplantation (ldlt).The patient did not have any emergency situation like intra-abdominal sepsis or bleeding or intestinal obstruction, and the decision to observe and follow up the patient was wise enough to avoid unnecessary surgical exploration.Spontaneous expulsion of the migrated vascular graft from the digestive tract occurred without any complications.The real mechanism for the migration of the thrombosed graft is not fully understood.We think that repeated endoscopic retrograde cholangio-pancreatography (ercp) sets for the management of anastomotic biliary stricture and repeated stent placements may play the major role in synthetic graft thrombosis and subsequent migration into the first part of the duodenum.
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