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CARDIOVASCULAR ANESTHESIA

Massive Gastrointestinal Bleeding Complicating Portal Vein Cross-Clamping During Liver Transplantation

Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada

Address correspondence and reprint requests to B. A. Finegan, MB, FFARCSI, FRCPC, Department of Anesthesiology and Pain Medicine, 3B2.32 W. C. Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada, T6G 2B7. Address e-mail to bfinegan{at}ualberta.ca

This case report describes the occurrence of massive upper gastrointestinal hemorrhage immediately after cross-clamping of the inferior vena cava and hepatic portal vein. This case suggests that acute intraoperative hemorrhage from a varix should always be a consideration before liver transplantation in patients who have a history of upper gastrointestinal bleeding.

IMPLICATIONS: A case of severe bleeding during liver transplantation is described in a patient who had a history of bleeding from the stomach before surgery. The importance of understanding surgical options and the ability to provide rapid massive transfusion in the management of this complication are discussed.