Lethal hypercytokinemia following hepatic resection under pringle maneuver: a case report.
Clinical implications of acute reactant cytokines remain to be clarified in ischemia/reperfusion injury of humans. We report a lethal case of hypercytokinemia following continuous Pringle maneuver. A 36-year-old man with intrahepatic duct stones underwent left lobectomy under continuous hepatic inflow occlusion for 70 minutes. The postoperative course was stormy with rapid deterioration of liver functions, resulting in death due to multiorgan dysfunction on the 4th postoperative day. Analysis of cytokines demonstrated marked elevation of plasma acute inflammatory cytokines level (Interleukin-6 and -8) during surgery and immediate postoperative day. Our experience suggests that excessive production of inflammatory cytokines was detrimentally associated with multiorgan dysfunction including liver. The strategies against such hypercytokinemia should be considered when performing liver resection particularly under continuous Pringle maneuver.
Hwang
Yoon-Jin
YJ
Department of Surgery, Biomolecular Engineering Center and Liver Research Institute Kyungpook, National University Hospital, Taegu, Korea.
Lee
Jong-Won
JW
Kim
Yang-Il
YI
D000328:Adult; D002763:Cholecystectomy; D002769:Cholelithiasis / Q000276:immunology / Q000601:surgery*; D016207:Cytokines / Q000097:blood*; D017809:Fatal Outcome; D042882:Gallstones / Q000601:surgery; D006498:Hepatectomy; D006500:Hepatic Duct, Common / Q000601:surgery*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008099:Liver / Q000098:blood supply*; D017093:Liver Failure / Q000276:immunology*; D008111:Liver Function Tests; D008297:Male; D009102:Multiple Organ Failure / Q000276:immunology; D011183:Postoperative Complications / Q000276:immunology*; D012008:Recurrence; D012086:Reoperation; D015427:Reperfusion Injury / Q000276:immunology*
D016207:Cytokines; D015850:Interleukin-6; D016209:Interleukin-8