title: Ischemic hepatitis after percutaneous nephrolitotomy: A case report.
abstract: BACKGROUND
  Ischemic hepatitis (IH) is the necrosis of the centrilobular hepatocytes of liver and is secondary to liver hypoperfusion in most of the cases. The diagnosis is usually based on biochemical findings due to the absence of symptoms and signs. Although the disease course is often mild, and sometimes is even not diagnosed, the outcome is poor if the etiology of hypotension and liver anoxia is not promptly corrected.
  
  
  METHODS
  A 64-year-old patient who underwent percutaneous nephrolithotomy (PNL) for right renal pelvic stone developed acute IH at first postoperative day as a result of hemorrhage related severe hypotension. After restoring hemodynamic parameters, she completely recovered 2 weeks after the operation.
  
  
  CONCLUSIONS
  IH is a frequent cause of marked serum aminotransferase elevation and most commonly occurs as a result of arterial hypoxemia and insufficient hepatic perfusion. Although no specific treatment of IH exists, stabilizing the hemodynamic parameters of the patient resolves the problem in most of the cases.
  
  
  CONCLUSIONS
  This case is presented to demonstrate that ischemic hepatitis should be kept in mind if severe hemorrhage occurs during PNL.
authors.affiliation: Department of Urology, Bitlis State Hospital, Besminare Mh. 13000, Besminare/BITLIS, Turkey. Electronic address: dr_mustafazafertemiz@hotmail.com.
authors.forename: Mustafa Zafer
authors.initials: MZ
authors.lastname: Temiz
authors.affiliation: Department of Urology, Bagcilar Training and Research Hospital, Merkez Mahallesi Mimar Sinan Caddesi 6. Sokak, Bagcilar/Istanbul, Turkey. Electronic address: emrah.yuruk@yahoo.com.
authors.forename: Emrah
authors.initials: E
authors.lastname: Yuruk
authors.affiliation: Department of Urology, Bitlis State Hospital, Besminare Mh. 13000, Besminare/BITLIS, Turkey. Electronic address: drteberik@gmail.com.
authors.forename: Kutlu
authors.initials: K
authors.lastname: Teberik
authors.affiliation: Department of Anesthesiology and Reanimation, Bitlis State Hospital, Besminare Mh. 13000, Besminare/BITLIS, Turkey. Electronic address: burcuakba@yahoo.com.tr.
authors.forename: Burcu Kadriye
authors.initials: BK
authors.lastname: Akbas
authors.affiliation: Department of Anesthesiology and Reanimation, Bitlis State Hospital, Besminare Mh. 13000, Besminare/BITLIS, Turkey. Electronic address: mdpiroglu@gmail.com.
authors.forename: Mustafa Devrim
authors.initials: MD
authors.lastname: Piroglu
authors.affiliation: Department of Internal Medicine, Bitlis State Hospital, Besminare Mh. 13000, Besminare/BITLIS, Turkey. Electronic address: drhandeslv@hotmail.com.
authors.forename: Hande Selvi
authors.initials: HS
authors.lastname: Oztorun
authors.affiliation: Department of Urology, Bagcilar Training and Research Hospital, Merkez Mahallesi Mimar Sinan Caddesi 6. Sokak, Bagcilar/Istanbul, Turkey. Electronic address: ekandirali@yahoo.com.
authors.forename: Engin
authors.initials: E
authors.lastname: Kandirali
keywords: Hemorrhage; Ischemic hepatitis; Percutaneous nephrolithotomy