Dupré A, Gagnière J, Tixier L, Ines DD, Perbet S, Pezet D, Buc E. Massive hepatic necrosis with toxic liver syndrome following portal vein ligation. World J Gastroenterol 2013; 19(18): 2826-2829 [PMID: 23687421 DOI: 10.3748/wjg.v19.i18.2826]
Corresponding Author of This Article
Dr. Emmanuel Buc, Department of Digestive and Hepatobiliary Surgery, CHU Estaing, 1 place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France. ebuc@chu-clermontferrand.fr
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
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World J Gastroenterol. May 14, 2013; 19(18): 2826-2829 Published online May 14, 2013. doi: 10.3748/wjg.v19.i18.2826
Massive hepatic necrosis with toxic liver syndrome following portal vein ligation
Aurélien Dupré, Johan Gagnière, Lucie Tixier, David Da Ines, Sébastien Perbet, Denis Pezet, Emmanuel Buc
Aurélien Dupré, Johan Gagnière, Denis Pezet, Emmanuel Buc, Department of Digestive and Hepatobiliary Surgery, CHU Estaing, 1 place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
Lucie Tixier, Department of Pathology, CHU Estaing, 1 place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
David Da Ines, Department of Radiology, CHU Estaing, 1 place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
Sébastien Perbet, Department of Anesthesia, CHU Estaing, 1 place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France
Author contributions: Dupré A and Gagnière J drafted the paper; Dupré A, Tixier L and Ines DD contributed to the imaging processing and analysis; Perbet S and Buc E critically revised the paper for important intellectual content; Pezet D and Buc E approved the final version to be published.
Correspondence to: Dr. Emmanuel Buc, Department of Digestive and Hepatobiliary Surgery, CHU Estaing, 1 place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France. ebuc@chu-clermontferrand.fr
Telephone: +33-47-3752389 Fax: +33-47-3750459
Received: November 16, 2012 Revised: January 23, 2013 Accepted: February 2, 2013 Published online: May 14, 2013 Processing time: 179 Days and 11 Hours
Abstract
Right portal vein ligation (PVL) is a safe and widespread procedure to induce controlateral liver hypertrophy for the treatment of bilobar colorectal liver metastases. We report a case of a 60-year-old man treated by both right PVL and ligation of the glissonian branches of segment 4 for colorectal liver metastases surrounding the right and median hepatic veins. After surgery, the patient developed massive hepatic necrosis with secondary pulmonary and renal insufficiency requiring transfer to the intensive care unit. This so-called toxic liver syndrome finally regressed after hemofiltration and positive oxygen therapy. Diagnosis of acute congestion of the ligated lobe was suspected. The mechanism suspected was an increase in arterial inflow secondary to portal vein ligation concomitant with a decrease in venous outflow due to liver metastases encircling the right and median hepatic vein. This is the first documented case of toxic liver syndrome in a non-cirrhotic patient with favorable issue, and a rare complication of PVL.
