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Ischemic hepatitis after percutaneous nephrolitotomy: A case report
Mustafa Zafer Temiz1, Emrah Yuruk2, Kutlu Teberik1
1Department of Urology, Bitlis State Hospital, Besminare Mh. 13000, Besminare/BITLIS, Turkey.
Insights
Ischemic hepatitis (IH), liver cell necrosis due to low blood flow, can occur after procedures like percutaneous nephrolithotomy (PNL). Promptly correcting hypotension is key to recovery.
Area of Science:
- Hepatology
- Nephrology
- Critical Care Medicine
Background:
- Ischemic hepatitis (IH) involves liver cell necrosis from hypoperfusion.
- Diagnosis relies on biochemical markers due to subtle symptoms.
- Poor outcomes occur if hypotension and liver anoxia are not addressed.
Purpose of the Study:
- To report a case of acute ischemic hepatitis following percutaneous nephrolithotomy (PNL).
- To highlight the association between severe hemorrhage during PNL and IH.
- To emphasize the importance of considering IH in post-PNL hypotension.
Main Methods:
- Case report of a 64-year-old female patient.
- Patient underwent percutaneous nephrolithotomy (PNL) for a renal pelvic stone.
- Diagnosis of acute IH was made on the first postoperative day due to severe hypotension from hemorrhage.
Main Results:
- The patient developed acute ischemic hepatitis post-PNL.
- Hemodynamic parameters were restored.
- Complete recovery was observed within 2 weeks.
Conclusions:
- Ischemic hepatitis is a common cause of elevated aminotransferases.
- It results from hypoxemia and insufficient hepatic perfusion.
- Stabilizing hemodynamics is the primary treatment for IH.
Introduction:
Ischemic hepatitis (IH) is the necrosis of the centrilobular hepatocytes of liver and is secondary to liver hypoperfusion in most of the cases. The diagnosis is usually based on biochemical findings due to the absence of symptoms and signs. Although the disease course is often mild, and sometimes is even not diagnosed, the outcome is poor if the etiology of hypotension and liver anoxia is not promptly corrected.
Presentation Of Case:
A 64-year-old patient who underwent percutaneous nephrolithotomy (PNL) for right renal pelvic stone developed acute IH at first postoperative day as a result of hemorrhage related severe hypotension. After restoring hemodynamic parameters, she completely recovered 2 weeks after the operation.
Discussion:
IH is a frequent cause of marked serum aminotransferase elevation and most commonly occurs as a result of arterial hypoxemia and insufficient hepatic perfusion. Although no specific treatment of IH exists, stabilizing the hemodynamic parameters of the patient resolves the problem in most of the cases.
Conclusion:
This case is presented to demonstrate that ischemic hepatitis should be kept in mind if severe hemorrhage occurs during PNL.
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