Abstract
A 60-year-old man who had received pylorus-preserving pancreatoduodenectomy for pancreatic head cancer 16 years previously underwent total gastrectomy, total pancreatectomy and splenectomy for cancer of the residual pancreatic body in October 2010. On post-operative day 3, he developed hepatorenal failure and disseminated intravascular coagulation and computed tomography revealed an alveolar internal structure in the left liver lobe, indicating a gas-forming liver abscess. Drainage was performed via a midline incision on post-operative day 7, and slight improvement in hepatorenal failure and disseminated intravascular coagulation was achieved. However, as inflammation and computed tomography findings remained unchanged, on post-operative day 15 the left liver lobe was resected to the extent possible and additional drainage was performed. The resected liver tissue exhibited sponge-like degeneration, all vascular tissue had disappeared and complete avascular necrosis had occurred. Based on these findings, gas gangrene of the liver was diagnosed. From post-operative day 40, the necrotized liver tissue naturally exfiltrated from the open midline incision and after 11 sharp surgical debridements, left liver lobe necrotic tissue was absent and inflammation had mostly resolved. Conventional drainage alone is insufficient to cure gas gangrene of the liver accompanying ischemia; removal of the necrotic tissue is required.
