Severe jaundice after rupture of abdominal aortic aneurysm

Eight patients after operation for ruptured abdominal aortic aneurysm developed severe jaundice. The jaundice became clinically apparent by the sixth postoperative day, and the average peak total bilirubin level reached 28.4 mg/100 ml, alkaline phosphatase level 8.6 BL units/l, and SGOT 95 Karmen units/ml. In addition to the hepatic dysfunction, all patients developed acute renal failure, seven of eight patients experienced hypovolemic shock, and six of eight patients had respiratory insufficiency requiring ventilatory support. The overall mortality was 83 per cent. The most probable causes for the severe jaundice were increased bile pigment load and hepatocellular dysfunction due to ischemic hypoxic injury of hepatocytes secondary to shock. Morphologically, a picture of cholestasis existed with severe bile-staining of hepatocytes and intracanalicular and intraductal bile thrombi. No evidence of recent or resolving hepatic necrosis was observed.