Acute Hepatic Failure after Open Repair for Infrarenal Abdominal Aortic Aneurysm in a Patient with Previous Laparotomies

Abstract

An 84 year-old female patient with a gradually expanding aneurysm in the infrarenal abdominal aorta was referred to our department. Although she had two previous laparotomies for uterine cancer, open repair was chosen because of inappropriate configuration for endovascular repair. Despite marked adhesions, we managed to complete aortic repair with infrarenal aortic cross-clamp. However, she unexpectedly developed liver dysfunction with marked elevations of creatine kinase and lactate. Computed tomography revealed diffuse liver necrosis, white blood test results indicated disseminated intravascular coagulation, the patients was thus diagnosed with acute liver failure. Since infrarenal aortic cross-clamping is unlikely to cause liver ischemia, repeated laparotomy with underlying adhesions might have been related to this event. This paper reports this unusual case with bibliographical considerations, focusing especially on the mechanism and measures for prevention.