Gastric volvulus in living, related liver transplantation donors and usefulness of endoscopic correction

Background: For cultural reasons, liver transplantation from living, related donors is common in Japan. This Is the first description of gastric volvulus as a complication in living, related liver donors and of the usefulness of endoscopic correction. Methods: One hundred fifteen donors from whom liver grafts were harvested for living, related liver transplantation between June 1990 and December 1999 were studied. Left lobectomy of the liver was performed In 47 cases, left lateral segmentectomy in 41, expanded lateral segmentectomy In 20, and expanded left lobectomy in 7 to provide liver grafts for recipients. If donors complained of symptoms of upper GI obstruction, EGD was performed. The diagnosis of gastric volvulus was based on characteristic endoscopic findings, and endoscopic correction was attempted. Results: Gastric mesenteroaxial volvulus was recognized in 13 of 115 donors (11.3%) after grafts of the liver were harvested. No significant correlation was found among gender, age, portion of the liver harvested, and the occurrence of gastric volvulus. After endoscopic correction, all donors except 1 became asymptomatic; after correction, recurrence of the volvulus was not observed. In the single donor who continued to have symptoms, insertion of a nasogastric tube for 14 days resulted in correction of the volvulus. Conclusions: The frequency of gastric volvulus among donors involved in living, related liver transplantation is high. Endoscopic correction of the volvulus is useful in dealing with this complication.