A 50-year-old man was pointed out hepatitis B virus infection when he underwent gastric cancer surgery. After that, he was treated with Entecavir. Hepatocellular carcinoma was pointed out during follow-up. We performed hepatic S8 subsegment resection. He was discharged without any complications. Four weeks after discharging, he developed a fever of 41°C, vomiting, diarrhea and delirium. He was transported by ambulance to our hospital. He was in a state of shock and DIC. We diagnosed septic shock. We performed circulation control and administered antibiotic and gamma globulin. We took measures against bacterial translocation. Aeromonas hydrophila was detected from blood and stool cultures. The clinical course was good, and he was discharged on the 14th day after hospitalization. A. hydrophila infection is known to become very serious in compromised hosts. This case had two risk factors: chronic hepatitis and post-gastrectomy. We here report a survived case of A. hydrophila infection.

An absence of the horizontal segment of the left portal vein was diagnosed by CT in a 37-year-old woman. The intrahepatic portal vein was running dorsal to the middle hepatic vein to supply the left lobe of liver, and the intrahepatic portal vein is presumed to be an anastomotic venous channel between the right anterior branch with umbilical portion of the portal vein, which was caused by absence of the horizontal segment of the left portal vein. Our case indicates the intrahepatic portal vein can course dorsal as well as ventral to the middle hepatic vein in patients with absence of the horizontal segment of the left portal vein.

A previously healthy 48-year-old woman was referred to our hospital because of liver injury. Her laboratory data on admission showed hepatocyte injury (AST 868 IU/L, ALT 1,205 IU/L. Alp 479 IU/L, γ-GTP 254 IU/L). She denied histories of alcohol intake or any medications. All viral markers related to hepatitis were negative. We suspected her having acute phase of autoimmune hepatitis despite of negative data in her serology. Liver biopsy revealed interface hepatitis with prominent infiltration of plasma cells. In addition, these plasma cells showed expressim of IgG4 by immunohistochemistry, and serum IgG4 levels were quite high (669 mg/mL). These findings leaded us to diagnose her as having IgG4-related autoimmune hepatitis (IgG4-AIH). Predonisolone (30 mg/day) promptly improved her liver injury and did not relapse even after reducing the dose. IgG4-AIH is a rare disease entity, and its precise pathogenesis is unknown yet. These issues should be addressed in the future.