[Postoperative reactive hepatitis in the septic patient]

After major surgery some patients, especially those with an infectiouss process or sepsis, develop jaundice which has been called reactive hepatitis, toxic hepatitis, septic hepatitis or benign postoperative cholestasis; these terms do not have a very precise connotation. Eighty patients with postoperative sepsis and jaundice where studied, excluding those with liver or biliary tract disease, hepato-toxic drugs or repeated halogenated anesthetics. All of them had complete laboratory tests, cultures and percutaneous liver biopsy when it was feasible. Thirty five patients were submitted to percutaneous liver biopsy and they are the material for this paper. There was no correlation with the type and duration of the operation, postoperative complications, shock or kind of anesthesia. The main laboratory changes were leukocytosis, neutrophilia, elevation of the bilirubins mainly the direct type and increase of the alkaline phosphatase; transaminases were within normal limits. Cultures were positive in 76% of the cases predominating E. coli, Pseudomonas a. and Proteus, anaerobics were present in 22.8% of the cases. The liver biopsy showed lymphoctic infiltration, hyperplasia of the Kupffer cells, hepatic regeneration and turbid tumefaction; pericholangitis, focal necrosis, retention of pigment and steatosis were less frequent. We consider that the best denomination of these complications is benign postoperative cholestasis.