Compression of the brachial plexus during right lobe liver donation as a cause of brachial plexus injury: A case report

✍ Scribed by Michael G. Dulitz; Andre M. De Wolf; Hak Wong; Chris Wray; Saadia Sherwani; Josh Herborn; Robert L. Sufit; Alan J. Koffron

• Publisher: John Wiley and Sons
• Year: 2005
• Tongue: English
• Weight: 90 KB
• Volume: 11
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.20343

✦ Synopsis

We present a case of brachial plexus injury in a livingrelated liver donor, most likely caused by compression of the plexus between the 1st rib and clavicle, the result of rib retraction for surgical exposure. (Liver Transpl 2005;11: 233-235.)

M ajor liver surgery usually requires the use of fixed metal retractors that pull the rib cage in an anterior and cephalad direction to provide adequate surgical exposure. Although this can result in a reduction in functional residual capacity of the lungs, the retraction of the rib cage is otherwise well-tolerated. We report a case of intraoperative compression of the right subclavian artery during rib cage retraction, resulting in lowered blood pressure readings from a right radial arterial catheter. Postoperatively, a right brachial plexus injury was diagnosed, from which the patient fully recovered after 8 -10 weeks. We suspect that brachial plexus injury after major liver surgery can be the result of nerve compression in the subclavian area caused by rib cage retraction to provide surgical exposure.