Unusual complication of pancreatic adenocarcinoma: massive liver necrosis

Pancreatic adenocarcinoma is a malignant and aggressive disease, whose diagnose is achieved in many cases at advanced stage. We present the case of a 63-year-old woman diagnosed with adenocarcinoma of the pancreatic head and body, which invaded hepatic artery and presented with portal vein thrombosis. She consulted for melena and upper endoscopy showed varicose lesions in the second part of duodenum. The patient developed acute worsening of anemia with hemodynamic inestability. Urgent contrast enhanced computed tomography revealed a massive hepatic necrosis without identification of the hepatic artery. Massive hepatic necrosis is an infrequent clinical condition described in bibliography after invasive procedures. The complete obstruction of the liver vascular system due to pancreatic cancer is an extremely unusual cause of massive liver necrosis.