Bleeding at Roux-en-Y jejunojejunal anastomosis after orthotopic liver transplantation

Allamneni_headshotPost written by Chaitanya Allamneni, MD, from the Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.

A young woman with a medical history of primary sclerosing cholangitis/autoimmune hepatitis overlap syndrome diagnosed at age 2, complicated by decompensated cirrhosis, underwent orthotopic liver transplantation (OLT). During OLT she underwent a standard Roux-en-Y hepaticojejunostomy. Twenty-four hours after OLT, she experienced hematochezia and acute anemia, raising concern for a luminal bleed as an adverse event of hepaticojejunostomy formation. She was subsequently referred for double-balloon enteroscopy, which revealed a patent jejuno-jejunal anastomosis. However, the anastomosis was actively oozing with a spurting visible vessel visualized. The anastomosis was injected with epinephrine for hemostasis, and 1 hemostatic clip was successfully placed. No further hematochezia occurred.

This case illustrates the effectiveness of endoscopy in treating an anastomotic leak and avoiding surgical intervention. Reaching such an anastomosis is technically difficult and requires single-balloon versus double-balloon enteroscopy. Deep enteroscopy, when available, assists in diagnosis and treatment at a major liver transplantation center.

Luminal GI bleeding immediately after Roux-en-Y creation should always raise suspicion for an anastomotic bleed. In this case, a spurting visible vessel was successfully managed with dual therapy of epinephrine injection and clipping.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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