Abstract
A 74-year-old man had recurrence of colorectal liver metastasis and synchronous lung metastasis. He underwent S1 resection of the remnant liver combined with the inferior vena cava resection under total hepatic vascular exclusion, and simultaneously underwent a partial lung resection. During the postoperative course, he suffered from septic shock due to severe pneumonia. Despite of intensive treatment such as continuous hemodiafiltration (CHDF), recovery was unable to be easily achieved. The relatively low serum cortisol levels and little response to the rapid ACTH test were observed. He was diagnosed as having adrenal insufficiency associated with critical illness and liver failure. The septic shock with little response to the catecholamine administration was treated with intravenous hydrocortisone administration and could be controlled. Thereafter, the patient recovered without a subsequent severe complication. If septic shock after major liver surgery is difficult to regulate despite catecholamine administration, adrenal insufficiency should be recognized as a differential diagnosis.
