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Complications in Living Liver Donors After Partial Liver Procurement: An Illustrative Radiologic Review

¹ Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap 2-dong, Songpa-ku, Seoul 138-736, Korea.
² Department of Radiology, National Cancer Center, Goyang, Korea.
³ Department of General Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —35-year-old woman with hepatic vein thrombosis after left hemiliver donation. Contrast-enhanced CT scan during portal venous phase obtained on postoperative day 7 shows area of hepatic congestion (asterisk) seen as area of hypoattenuation surrounded by hyperattenuation and nonopacification of middle hepatic vein (arrowhead).

View larger version (58K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —35-year-old woman with hepatic vein thrombosis after left hemiliver donation. Color Doppler sonogram obtained 4 weeks after A shows reversed flow of middle hepatic vein tributary (arrowhead), suggesting development of intrahepatic collateral drainage into right hepatic vein (arrow).

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —35-year-old woman with hepatic vein thrombosis after left hemiliver donation. Follow-up contrast-enhanced CT scan during portal venous phase shows intrahepatic collateral circuit (circle).

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —31-year-old man with hepatic infarction in remnant segment IV after left lateral sectionectomy. Contrast-enhanced CT scan during portal venous phase obtained 4 weeks after left lateral sectionectomy shows well-defined area of hepatic infarction (arrowheads) seen as marked low attenuation.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —31-year-old man with hepatic infarction in remnant segment IV after left lateral sectionectomy. Follow-up contrast-enhanced CT scan obtained 4 months after initial postoperative CT scan shows marked shrinkage of remnant segment IV.

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —23-year-old man with caudate lobe ischemia after left hemiliver donation. Preoperative oblique coronal maximum-intensity-projection image clearly shows large and protruded papillary process of caudate lobe (arrows) supplied by small branch (arrowheads) of left portal vein.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —23-year-old man with caudate lobe ischemia after left hemiliver donation. Contrast-enhanced CT scan obtained on postoperative day 7 shows hypoattenuation and swelling of caudate lobe (arrows), suggesting infarction due to deprivation of portal inflow. CT scan also shows mottled air density in hypoattenuation area, suggesting combined infection.

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —23-year-old man with caudate lobe ischemia after left hemiliver donation. Follow-up contrast-enhanced CT scan obtained 1 month after the initial postoperative CT shows marked shrinkage of caudate lobe (arrows).

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —21-year-old man with massive peritoneal bleeding from right hepatic artery stump after right hemiliver donation. Unenhanced CT scan shows acute hematoma on postoperative day 1, seen as high attenuation (arrows) in right subphrenic area. CT scan also shows postoperative pneumoperitoneum and right pleural effusion.

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —21-year-old man with massive peritoneal bleeding from right hepatic artery stump after right hemiliver donation. Axial contrast-enhanced CT scan during hepatic arterial phase shows active extravasation (arrowheads) of contrast agent from right hepatic artery stump.

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —21-year-old man with massive peritoneal bleeding from right hepatic artery stump after right hemiliver donation. Oblique coronal maximum-intensity-projection image clearly shows active extravasation (arrowheads) of contrast agent from right hepatic artery stump. At surgery, active bleeding from right hepatic artery stump with dislodgement of hemoclip was found.

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —33-year-old woman after left hemiliver donation with subcapsular postbiopsy hematoma. Unenhanced CT scan obtained on postoperative day 1 shows large subcapsular hematoma (arrowheads), seen as heterogeneous high attenuation compared with hepatic parenchyma.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —33-year-old woman after left hemiliver donation with subcapsular postbiopsy hematoma. Contrast-enhanced CT scan of liver during arterial phase shows congestion of compressed hepatic parenchyma (asterisk, right anterior sector), seen as high attenuation compared with normal parenchyma (arrowheads, right posterior sector). CT scan also shows early opacification of right anterior portal vein (arrows), supporting hypothesis that portal vein may act as draining vein in acute hepatic outflow obstruction.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —44-year-old man with right adrenal hemorrhage after left hemiliver donation. Unenhanced CT scan obtained on postoperative day 19 shows acute hematoma (arrowheads) in right adrenal gland, seen as high-attenuation lesion (> 70 H). Follow-up contrast-enhanced CT scans obtained 1 month after initial postoperative CT showed decreased size and attenuation of right adrenal hematoma (not shown).

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —22-year-old woman with biloma after right hemiliver donation. Contrast-enhanced CT scan during portal venous phase obtained on postoperative day 36 reveals persistent fluid collection (arrowheads) in right posterior subphrenic space adjacent to hepatic resection margin and right pleural effusion.

View larger version (46K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —22-year-old woman with biloma after right hemiliver donation. Hepatobiliary scans using 99mTc-diisopropyl iminodiacetic acid (DISIDA) show focal bile activity (arrowheads) at posterior aspect of resection margin during excretion phase, suggesting bile leakage.

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —21-year-old man with biloma after right hemiliver donation. Color Doppler sonogram obtained on postoperative day 13 shows biloma (asterisk) at resection margin in right subphrenic area and displacement of middle hepatic vein. Doppler spectrogram showed dampened and monotonous venous flow (not shown).

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —21-year-old man with biloma after right hemiliver donation. Color Doppler sonogram shows reversal of portal flow (arrows), shown in blue, in segment IV and in left portal vein umbilical segment.

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8C —21-year-old man with biloma after right hemiliver donation. Contrast-enhanced CT scan during hepatic arterial phase shows biloma compressing hepatic parenchyma. CT scan also shows early opacification of portal branch (arrowhead) in segment VIII. CT and color Doppler sonogram after removal of biloma showed recovery of hepatic venous and portal flow (not shown).

View larger version (96K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —28-year-old man with biloma after right hemiliver donation. Oblique coronal sonogram obtained on postoperative day 7 shows large fluid collection containing internal debris (asterisk) at resection margin, suggesting biloma with secondary infection. Sonogram also shows right pleural effusion.

View larger version (155K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —28-year-old man with biloma after right hemiliver donation. Abscessogram reveals opacification of biliary tree and communicating tract (arrowhead) between abscess and intrahepatic bile duct.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10A —23-year-old man with bile stricture after right hemiliver donation. MR cholangiogram obtained on postoperative day 22 shows segmental narrowing (arrow) of proximal common hepatic duct.

View larger version (162K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10B —23-year-old man with bile stricture after right hemiliver donation. Direct cholangiogram shows focal stenosis (arrow) of proximal common hepatic duct.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11A —21-year-old woman with portal vein thrombosis after right hemiliver donation. Contrast-enhanced CT scan obtained on postoperative day 4 shows focal filling defect (arrowhead) in main portal vein, suggesting thrombosis.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11B —21-year-old woman with portal vein thrombosis after right hemiliver donation. Indirect portogram by splenic arteriography shows abrupt cutoff of portal vein (arrowheads) and regurgitation of contrast material into superior mesenteric vein. Surgical thrombectomy was performed, and metallic stent was inserted into portal vein.

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12 —41-year-old man with adhesive band ileus after right hemiliver donation. Coronal reconstruction image obtained on postoperative day 7 shows diffuse small bowel ileus with close attachment of collapsed loops (arrowheads) along abdominal incision wound.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 13 —37-year-old man with gastric volvulus after left hemiliver donation. Upper gastrointestinal series shows upward rotation of distal portion of stomach with mild contrast material passage disturbance probably caused by fixation of distal stomach to liver resection margin, suggesting gastric volvulus.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 14 —46-year-old man with incisional hernia after right hemiliver donation. Contrast-enhanced CT scan obtained 5 months after right hemihepatectomy shows small-bowel hernia (arrowheads) through incisional site to subcutaneous fat. There is no evidence of strangulation or obstruction.

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