[A death caused by fulminant B-hepatitis which was latent preoperatively]

It is not always easy to evaluate the preoperative liver functions exactly. In this paper we report a patient who died of fulminant hepatitis postoperatively in spite of careful examination of preoperative liver functions. A 60-year-old male had severe bleeding following total cystectomy, resulting in cardiac arrest. He was resuscitated successfully but developed multiple organ failure. He came through it but thereafter he had repeated infectious episodes from uretero-cutaneous fistula and fluctuation of liver functions. Seven months later he had repair of postoperative ventral hernia. His liver functions were within normal limits except for positive HBs antigen. But eventually the patient died of acute fulminant transfusion hepatitis B 30 days after the operation. A cause of his death was, we presume, loading stress of surgical operation on the acute stage of hepatitis B. Other possible causes or deteriorating factors were drug liver injury, alcoholic chronic hepatitis, and coincidence of non A-non B hepatitis. When HBs antigen is positive in spite of normal liver function test, differential diagnosis between asymptomatic carrier and the first stage of acute hepatitis B should be made carefully.