Published online Mar 21, 2016. doi: 10.3748/wjg.v22.i11.3289
Peer-review started: May 25, 2015
First decision: July 19, 2015
Revised: September 5, 2015
Accepted: November 30, 2015
Article in press: December 1, 2015
Published online: March 21, 2016
Processing time: 294 Days and 14.9 Hours
Post-hepatectomy liver failure (PHLF) is a leading cause of morbidity and mortality following major liver resection. The development of PHLF is dependent on the volume of the remaining liver tissue and hepatocyte function. Without effective pre-operative assessment, patients with undiagnosed liver disease could be at increased risk of PHLF. We report a case of a 60-year-old male patient with PHLF secondary to undiagnosed alpha-1-antitrypsin deficiency (AATD) following major liver resection. He initially presented with acute large bowel obstruction secondary to a colorectal adenocarcinoma, which had metastasized to the liver. There was no significant past medical history apart from mild chronic obstructive pulmonary disease. After colonic surgery and liver directed neo-adjuvant chemotherapy, he underwent a laparoscopic partially extended right hepatectomy and radio-frequency ablation. Post-operatively he developed PHLF. The cause of PHLF remained unknown, prompting re-analysis of the histology, which showed evidence of AATD. He subsequently developed progressive liver dysfunction, portal hypertension, and eventually an extensive parastomal bleed, which led to his death; this was ultimately due to a combination of AATD and chemotherapy. This case highlights that formal testing for AATD in all patients with a known history of chronic obstructive pulmonary disease, heavy smoking, or strong family history could help prevent the development of PHLF in patients undergoing major liver resection.
Core tip: A report of a 60-year-old male who underwent an extended right hepatectomy for metastatic colorectal adenocarcinoma. He subsequently developed post-hepatectomy liver failure secondary to a delayed diagnosis of alpha-1-antitrypsin deficiency. Clinicians should be aware of, and test for, the possibility of undiagnosed alpha-1-antitrypsin deficiency in patients with known chronic obstructive pulmonary disease or a family history, undergoing major liver resection.