Abdominal Pain and Hematochezia in a Liver Transplant Recipient

摘要

A 58-year-old woman underwent living donor liver transplantation 6 years ago for hepatitis C virus (HCV) cirrhosis and hepatocellular cancer. She had a favorable clinical outcome and was maintained on low dose (<6 ng/mL) tacrolimus monotherapy. She presented in the emergency department with abdominal pain, asthenia and hemorrhagic diarrhea 1 week after a complete checkup, including protocol percutaneous liver biopsy ultrasound assisted (site marking). All checkup examinations, including biochemistry, histology and abdominal ultrasound, were within normal ranges. At admission in the emergency department, physical examination revealed abdominal tenderness. As biochemistry (Hgb 12.0 mg/dL) and upper gastrointestinal (GI) endoscopy, colono- and proctoscopy were normal, she was discharged 2 days later, in good and stable condition. Some days later, she had again to be readmitted for similar abdominal pain and severe hematochezia (important loss of fresh blood without stools). Physical examination was unchanged. Biochemistry only revealed moderate anemia (Hgb 10.0 mg/dL); liver and pancreas tests were normal. Repeat GI endoscopy examination was again completely normal. Abdominal contrast computed tomography scan showed an allograft with normal contour and parenchyma; after contrast medium injection, a very rapid appearing portography was identified in the presence of moderate esophageal varices (Figure 1). The patient underwent interventional radiology (Figures 2 and 3). She was discharged after 3 days as she recovered very rapidly without any new bleeding episode. Serial Doppler-ultrasound examinations confirmed the successful radiological intervention. The patient is now doing well 4 months after interventional radiology; she had no further episodes of GI bleeding.