title: Massive hepatic necrosis with toxic liver syndrome following portal vein ligation.
abstract: Right portal vein ligation (PVL) is a safe and widespread procedure to induce controlateral liver hypertrophy for the treatment of bilobar colorectal liver metastases. We report a case of a 60-year-old man treated by both right PVL and ligation of the glissonian branches of segment 4 for colorectal liver metastases surrounding the right and median hepatic veins. After surgery, the patient developed massive hepatic necrosis with secondary pulmonary and renal insufficiency requiring transfer to the intensive care unit. This so-called toxic liver syndrome finally regressed after hemofiltration and positive oxygen therapy. Diagnosis of acute congestion of the ligated lobe was suspected. The mechanism suspected was an increase in arterial inflow secondary to portal vein ligation concomitant with a decrease in venous outflow due to liver metastases encircling the right and median hepatic vein. This is the first documented case of toxic liver syndrome in a non-cirrhotic patient with favorable issue, and a rare complication of PVL.
authors.affiliation: Department of Digestive and Hepatobiliary Surgery, CHU Estaing, 1 Place Lucie et Raymond Aubrac, 63003 Clermont-Ferrand, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Dupré
authors.forename: Johan
authors.initials: J
authors.lastname: Gagnière
authors.forename: Lucie
authors.initials: L
authors.lastname: Tixier
authors.forename: David
authors.initials: D
authors.lastname: Da Ines
authors.forename: Sébastien
authors.initials: S
authors.lastname: Perbet
authors.forename: Denis
authors.initials: D
authors.lastname: Pezet
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Buc
mesh_terms: D001706:Biopsy; D015179:Colorectal Neoplasms / Q000473:pathology*; D006440:Hemofiltration; D006801:Humans; D008026:Ligation; D008107:Liver Diseases / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009336:Necrosis; D010102:Oxygen Inhalation Therapy; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D051437:Renal Insufficiency / Q000209:etiology; D012131:Respiratory Insufficiency / Q000209:etiology; D013577:Syndrome; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
keywords: Colorectal liver metastases; Hemofiltration; Liver failure; Portal vein ligation; Toxic liver syndrome