MASSIVE HEPATIC INFARCTION FOLLOWING TOTAL GASTRECTOMY-A CASE REPORT-

Although massive hepatic infarction after abdominal surgery is uncommon, the prognosis is poor. Here we report a case of massive hepatic infarction following total gastrectomy. A 67-year-old woman presenting with vomiting and upper abdominal disturbance was admitted. She had a history of distal partial gastrectomy 19 years previously because of gastric cancer. A series of examinations revealed advanced cancer at the pregastroduodenal anastomosis site. She underwent surgery on October 23, 1998. Because of cancer invasion to adjacent organs, total gastrectomy combined with caudal pancreatectomy and splenectomy, partial hepatectomy and partial resection of jejunum were performed. Bile leakage was observed through the drain placed in the abdominal cavity on the 1st day after the operation. Serum transaminase levels increased remarkably, and CT scan revealed a massive hepatic infarction in the left lobe, S5 and the surrounding area of the right portal vein. Transaminase levels normalized two weeks after the operation. Abdominal angiography demonstrated obstruction of the proper hepatic artery and left branch of the portal vein. The area of hepatic infarction decreased in size gradually thought bile leakage persisted. The patient was discharged on July 11, 1999.