Chapter 89: Abdominal Fluid Collections

INTRODUCTION

• Intraabdominal fluid collections occur commonly after liver transplantation.¹ Most of them are asymptomatic, sterile, and resolve spontaneously. However, up to 10% are infected and can affect graft and patient survival. Liver abscesses, if untreated, can be fatal.²

• A thorough knowledge of the most common localizations and characteristics of fluid collections leads to early diagnosis and treatment.

• Large collections can compress vascular or biliary structures.

• Bilomas may alert of bile leak or arterial insufficiency.

• Hematomas should warn about bleeding, and they can also become infected.

ETIOLOGY AND MOST COMMON LOCALIZATIONS

• Hematomas, seromas, bilomas, localized ascites, and abscesses are most commonly found. Imaging surveillance is crucial for early detection of postoperative complications^3,4 (Table 89-1) (Fig. 89-1).

• Peritoneal reflections around the liver are divided during transplantation, which changes the distribution pattern of fluid in liver transplant recipients.

• In the transplanted patient, fluid appears to accumulate more frequently in the teres ligamentum. Visualization of this ligament may help localize the collection more accurately (Fig. 89-2).

• During liver transplant surgery, the right superior and right inferior coronary ligament is divided, communicating the right posterior subphrenic and subhepatic spaces (Morrison pouch). This allows for fluid collections to cover the whole posterior surface of the liver, including the bare area (which is normally retroperitoneal) (Figs. 89-3 to 89-8).

• Collections occur most frequently in the right upper quadrant or subhepatic space, although they may be found anywhere within the abdomen.

• Fluid collections and hematomas are often adjacent to vascular and biliary anastomoses.

• It is important to distinguish between intrahepatic and extrahepatic collections. Intrahepatic collections are usually bilomas and, in rare cases, hematomas.

• Small extrahepatic collections are more likely to resolve spontaneously.