Spontaneous migration of thrombosed synthetic vascular graft to the duodenum after living-donor liver transplantation: A case-report.

Introduction: Spontaneous migration of synthetic grafts had been described after abdominal vascular procedures into the duodenum and small bowel. In the setting of liver transplantation, synthetic grafts are commonly used for overcoming shortened or poor-quality vasculatures. We describe a case of spontaneous migration of thrombosed synthetic vascular graft after living-donor liver transplantation (LDLT).

Presentation: A 59 years male patient with end stage liver disease underwent LDLT utilizing a right hemi-liver graft. Drainage of segment V vein was done to inferior vena cava using a vascular graft. Graft patency was confirmed by regular follow up doppler ultrasound. Graft thrombosis was detected on the 4th postoperative month. The patient developed anastomotic biliary stricture 3 months after LDLT, which required repeated endoscopic retrograde cholangio-pancreatography (ERCP). During an ERCP set two and half years after LDLT, the thrombosed graft was seen eroding into the first part of the duodenum. The patient was generally stable and the decision was to follow up the condition. Follow up computed tomography showed disappearance of the graft from the abdomen, and endoscopy revealed a small ulcer at the site of the migrated graft.

Discussion: Reports regarding spontaneous migration of synthetic grafts in this setting of LDLT are extremely rare. We report a rare case of spontaneous migration of thrombosed synthetic vascular graft into the duodenum after LDLT.

Conclusion: We report a rare case of spontaneous migration of thrombosed synthetic vascular graft into the duodenum after LDLT.