title: Acute lower limb ischemia as a triggering condition in hypoxic hepatitis: a study of five cases.
abstract: OBJECTIVE
  Acute centrilobular liver cell necrosis in hypoxic hepatitis (HH) occurs mainly in the setting of hemodynamic failure owing to cardiac failure, respiratory failure, and septic-toxic shock. Cases of HH were also reported under specific conditions such as heat stroke, grand mal seizure, obstructive sleep apnea, and complicated aortic aneurysm. In this study, we report 5 cases of HH occurring in the course of acute lower limb ischemia (ALLI). To the best of our knowledge, the association between HH and ALLI has not yet been reported.
  
  
  METHODS
  In a prospective and consecutive series of 142 cases of HH, we identified 5 cases (3.5%) in which ALLI was the triggering condition. The clinical, hemodynamic, and liver laboratory data of these 5 cases are reported. A review of the literature on liver injury observed in the case of ALLI is also made.
  
  
  RESULTS
  The 5 patients were 4 males and 1 female of mean age 63 years. All 5 had typical HH after ALLI. Four of them were in shock on admission. Arterial blood pH lower than 7.15 was observed upon admission in the 3 patients who died. Other potential causes of liver hypoxia were present in all patients. Urgent and efficient revascularization of the ischemic limb was a necessary condition for survival.
  
  
  CONCLUSIONS
  Acute lower limb ischemia should be added to the list of conditions able to trigger HH. In this particular setting, urgent revascularization of the ischemic limb seems to be a prerequisite for survival.
authors.affiliation: Department of Hepatogastroenterology, Haine-Saint-Paul, Belgium. jeanhenrion@yahoo.fr
authors.forename: Jean
authors.initials: J
authors.lastname: Henrion
authors.forename: Pierre
authors.initials: P
authors.lastname: Deltenre
authors.forename: Stéphane
authors.initials: S
authors.lastname: De Maeght
authors.forename: Marie-Odile
authors.initials: MO
authors.lastname: Peny
authors.forename: Michael
authors.initials: M
authors.lastname: Schapira
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology; D006439:Hemodynamics; D006505:Hepatitis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D000860:Hypoxia / Q000209:etiology* / Q000503:physiopathology; D007511:Ischemia / Q000150:complications* / Q000503:physiopathology; D008099:Liver / Q000098:blood supply / Q000378:metabolism / Q000473:pathology; D035002:Lower Extremity / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000150:complications / Q000503:physiopathology; D012772:Shock, Septic / Q000150:complications / Q000503:physiopathology