Multidisciplinary Treatment for Hyperbilirubinemia after Extended Hepatectomy in a Patient with Multiple Metastatic Liver Cancer

Kazuhisa Takeda, Kaoru Nagahori, Mitsuyoshi Ota, Hirotoshi Akiyama, Hideaki Kimura, Kotaro Nagamine, Hitoshi Sekido, Shinji Togo and Hiroshi Shimada

Department of Surgery II, Yokohama City University School of Medicine

We found that multidisciplinary treatment was effective in hyperbilirubinemia after extended hepatectomy. In a 58-year-old man undergoing sigmoidectomy for sigmoid colon cancer, a metastatic liver tumor was found in all segments but S1 and S5 of the liver. Staged hepatectomy was conducted to remove all segments but these two. The patient's fever rose and hyperbilirubinemia appeared postoperatively, and then he suffered liver failure. Methicillin-resistant Staphylococcus epidermidis and Enterococcus faecalis were detected from a blood culture. A liver biopsy disclosed sinusoidal fibrosis. The remnant liver volume increased to 96% of the preoperative volume 43 days after the second hepatectomy. Even after the infection was successfully controlled, the hyperbilirubinemia still continued. After the treatment with hyperbaric oxygenation (HBO) and the administration of ursodeoxycholic acid (UDCA), steroids, and phenobarbital, the total bilirubin level decreased. Hypoxia of hepatocytes may have been improved by the HBO, and the cholagogic function also improved by the steroids and UDCA.

Key words
massive hepatectomy, hyperbilirubinemia, multidisciplinary treatment

Reprint requests
Kazuhisa Takeda Second Department of Surgery, Yokohama City University School of Medicine 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 JAPAN

Accepted
October 30, 2002

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