A case of liver infarction after pancreaticoduodenectomy

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  • 膵頭十二指腸切除術後に発症した肝梗塞の1例
  • 症例 膵頭十二指腸切除術後に発症した肝梗塞の1例
  • ショウレイ スイトウ ジュウニシチョウ セツジョ ジュツゴ ニ ハッショウ シタ カン コウソク ノ 1レイ

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Abstract

A 35-year-old man who visited elsewhere hospital because of abdominal distention due to constipation was referred to our hospital for the purpose of close exploration and treatment for seriousness of his abdominal distention. When he was first seen, physical examinations disclosed bulbar conjunctiva yellowing and abdominal distention. There were no specific previous medical histories. Following close examinations after admission, cancer of the pancreas head was diagnosed. Pancreaticoduodenecomy with reconstruction by means of Child modified procedure was performed. Pathology revealed poorly differentiated tubular adenocarcinoma, with a part of spindle-shaped cells. The disease was rated T4N1M0 in stage IVa. Blood biochemical examination performed on the postoperative day first showed remarkably increased levels of AST, 1,303 IU/l, and ALT, 2,110 IU/l. On contrast enhanced CT scan, a low density area was confirmed in the portal phase rather than in the artery phase, so that liver infarction was diagnosed. Probable cause of his liver infarction might the disturbance of blood flow caused by retractor or taping. Administration of PGE1 preparation, protease inhibitor and antibiotics was successful and the patient was discharged.

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