A Curious Case of Methemoglobinemia Complicating a Pediatric Live Donor Liver Transplantation Surgery.

Background: Pediatric live donor liver transplantation (LDLT) surgery is by itself a complicated surgery. Added to the difficulty in the operative technique are the complex preoperative work-up, optimization, and postoperative treatment. Intraoperative events and immediate postoperative recovery are important in graft function and the patient's overall recovery. Intraoperative greenish-blue urine and hypoxia are seldom seen during this period in the case of LDLT. Knowing the differential diagnosis and treatment are of predominant importance.

Methods: A case of decompensated chronic liver disease due to Wilson's disease underwent routine LDLT. Here we describe an uncommon complication, methemoglobinemia, which complicated this patient's recovery. The case is presented for the condition's rarity and the confusing clinical picture it produced.

Results: Observations of greenish-blue urine, ascites, serum, gastric aspirate, bile, maroon or brown-colored blood, and hypoxia with normal PaO were made in this case. Timely diagnosis of suspected drug-induced methemoglobinemia and treatment, which led to the uneventful recovery of the patient, are explained.

Conclusion: Even though methemoglobinemia does not have a direct graft effect, it can affect the graft oxygen perfusion and the overall oxygenation of the postoperative patient, causing adverse impacts if not detected and treated promptly. No such association of methemoglobinemia with Wilson's disease or during transplantation has been reported in the literature so far.