Traumatic and postoperative ischemic liver necrosis: Causes, risk factors and treatment

Background: To study the cause and outcome of ischemic liver necrosis and s uggest treatment of these patients. Methods: Retrospective study of 13 pati ents with ischemic liver necrosis treated at our departments from 1990 unti l 1997. Results: Ischemic liver necrosis was caused by general hypoxia (n = 1) or acute arterial occlusion (n = 12) of the celiac and superior mesente ric artery (SMA, n = 3), proper hepatic artery (PHA, n = 1), right hepatic artery (RHA, n = 2), left hepatic artery (LHA, n = 2) and intrahepatic vess els (n = 4). Six of the cases were related to surgical procedures, 5 of the se (38%) were unintended arterial injuries after biliary surgery. Ten patie nts (77%) had risk factors contributing to the development of liver necrosi s: septicemia (n = 4), jaundice and septicemia (n = 2), shock and hypoxia ( n = 3) and alcoholic cirrhosis (n = 1). Five patients (38%) needed resectio n of the liver necrosis due to infected necrosis. Three patients (23%) died ; two of these had celiac/SMA occlusion. One died due to complete gastroint estinal ischemia and severe lactacidosis, two died of multiorgan failure af ter bile leakage and septicemia. Conclusion: Ischemic liver necrosis is mai nly caused by arterial occlusion due to arteriosclerosis, arterial transect ion during biliary surgery or blunt liver trauma, and seldom occurs without additional risk factors. 50% of the patients develop infected necrosis and need liver resection. Patients with sterile necrosis may recover without s urgical procedures of the liver. The mortality in patients with central (ce liac/ SMA) and peripheral (CHA, PHA, RHA, LHA, intrahepatic branches) occlu sions was 67% (2/3) and 11% (1/9), respectively. Copyright (C) 2000 S. Karg er AG, Basel.