Adhesive Small Bowel Obstruction at the Dissected Plane of a Liver Graft After Living Donor Liver Transplantation: A Pediatric Case Report

Abstract

Adhesive small bowel obstruction is a relatively rare surgical complication after liver transplantation. We report on a case of adhesive small bowel obstruction at the dissected plane of a liver graft. An 8-year-old girl was admitted to our hospital for abdominal pain and diagnosed as having a postoperative adhesive bowel obstruction. The patient had undergone living donor liver transplantation to treat citrullinemia at age 6. She was initially treated conservatively using an ileus tube; however, the bowel obstruction recurred when oral intake resumed. The patient’s abdominal Computed tomography images showed that the dilated small bowel was obstructed by an adhesive band in the right upper quadrant. Emergency laparotomy was performed, and we observed a strong adhesion of that to the colon and abdominal wall. There was also marked adhesion of the small bowel to the dissected plane of the liver graft. Adhesiolysis and partial resection of the small bowel were performed. Her postoperative course was uneventful. She was discharged on postoperative day 14. Massive small bowel adhesion to the dissection plane of the liver graft can cause severe surgical complications after partial liver transplantation. To avoid re-laparotomy due to adhesive small bowel obstruction, it is necessary to apply adhesion barrier agents to the small bowel and to the dissected plane of the liver graft.