title: Two cases of hepatic artery interruption after hepatopancreatobiliary surgery treated by prostaglandin E(1) infusion via the superior mesenteric artery.
abstract: In two cases of hepatic arterial flow interruption after hepatopancreatic surgery, continuous PGE(1) infusion from the superior mesenteric artery (SMA) was applied to oxygenate the liver through the portal vein. Case 1 was a 69-year-old woman with a non-functioning islet cell tumor of the pancreas. She underwent pancreatic resection following hepatic arterial infusion of anticancer drugs. Serum alanine aminotransferase (ALT) was elevated to 5500 IU/l on postoperative day (POD) 2; angiography revealed complete celiac artery obstruction. Continuous PGE(1) was administered from SMA at a rate of 0.01 &mgr;g/kg/min for 7 days. Serum ALT was normalized within 2 weeks and the peak level of serum total bilirubin (T. Bil) was 4.5 mg/dl. Case 2 was a 66-year-old man suffering from metastatic liver cancer. Complete obstruction of the proper hepatic artery was noted at the time of liver resection after hepatic arterial chemotherapy. Serum ALT was elevated to 2930 IU/l on POD 1, and PGE(1) infusion from SMA was done for the succeeding 7 days. Necrotic area was so vast that serum T. Bil rose to 19 mg/dl. However, it decreased with time. Both cases required 3 months for necrotic liver shrinkage. Doppler ultrasonography revealed that PGE(1) infusion actually increased portal blood flow. In conclusion, based on the preceding experimental backgrounds and clinical experiences, continuous PGE(1) infusion via the SMA can be a useful measure to prevent severe liver damage after hepatic arterial flow interruption through portal blood oxygenation.
authors.affiliation: Department of Surgery, Akita University School of Medicine, 1-1-1 Hondo, 010-8543, Akita, Japan
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Sato
authors.forename: Ouki
authors.initials: O
authors.lastname: Yasui
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Kurokawa
authors.forename: Hideaki
authors.initials: H
authors.lastname: Andoh
authors.forename: Masato
authors.initials: M
authors.lastname: Yoshioka
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Asanuma
authors.forename: Manabu
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Koyama