Fatal liver gas gangrene after biliary surgery. (2017)

• Record Type: Journal Article
• Authors: Miyata, Yui; Kashiwagi, Hiroyuki; Koizumi, Kazuya; Kawachi, Jun; Kudo, Madoka; Teshima, Shinichi; Isogai, Naoko; Miyake, Katsunori; Shimoyama, Rai; Fukai, Ryota; Ogino, Hidemitsu
• Is Part Of: International journal of surgery case reports. Volume 39(2017)
• Page Start: 5
• Page End: 8
• Publication Date: 2017
• Subjects: Fatal liver abscess -- Liver gas gangrene -- Post biliary reconstruction; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2017.07.049
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Liver gas gangrene is a rare condition with a highly mortality rate. Development of liver gas gangrene is associated with host conditions such as malignancy and immunosuppression. We report a case of liver gas gangrene after biliary surgery which is one of the risks of the liver parenchymal infection. Abstract: Introduction: Liver gas gangrene is a rare condition with a highly mortality rate. It is mostly associated with host factors, such as malignancy and immunosuppression. Presentation of case: A 57-year-old female was admitted to our hospital with abnormalities of her serum hepato-biliary enzymes. She had a history of hypertension, diabetes mellitus, cerebral infarction, and chronic renal failure. She was diagnosed with bile duct cancer of the liver hilum and a left hepatectomy was carried out, with extrahepatic bile duct resection. Initially her post-operative state was uneventful. However, she suddenly developed melena with anemia on post-operative day (POD) 18. A Computed tomography (CT) examination on POD 19 revealed a massive build up of gas and portal gas formation in the anterior segment of the liver. Although we immediately provided the drainage and a probe laparotomy, she died on POD 20 due to shock with disseminated intravascular coagulation. Discussion: Liver gas gangrene is rare and has a high mortality rate. This case seems to have arisen from an immunosuppressive state after major surgery with biliary reconstruction for bile duct cancer and subsequent gastrointestinal bleeding, leading to gas gangrene of the liver.