TRANSIENT CHOLESTATIC HEPATITIS AFTER GEN ERAL-ANESTHESIA IN A PATIENT WITH ALAGILLES-SYNDROME

A 27-year-old female patient with partial Alagille's syndrome (hypopla sia of the intrahepatic bile ducts, typical facial dysmorphism and ske letal anomalies) developed a marked cholestasis (total bilirubin 59 mg /dl), decrease of liver synthesis tests and ascites four weeks after g ynecological surgery with general anesthesia involving propofol, isofl urane and nitrous oxide. Slow recovery could be achieved under treatme nt with ursodeoxycholic acid, spironolactone and substitution of fat-s oluble vitamins A, D, E and K. Four months after admission the ascites had disappeared, liver synthesis had increased and the total bilirubi n level had dropped to 3.8 mg/dl. Since all other possible causes were excluded during the hospital stay, the prolonged episode of cholestas is in this patient is best explained by the preceding general anesthes ia with propofol which is known to be metabolished in the liver and im pedes hepatic cytochrome P450 and hepatic blood flow.