Nonalcoholic steatohepatitis (NASH) after pancreaticoduodenectomy: Association of pancreatic exocrine deficiency and infection

Yasuhiro Murata, Shugo Mizuno, Hiroyuki Kato, Masashi Kishiwada, Ichiro Ohsawa, Takashi Hamada, Masanobu Usui, Hiroyuki Sakurai, Masami Tabata, Keisuke Nishimura, Kazuo Fukutome, Shuji Isaji

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

Abstract

Previous clinical study has demonstrated that 30-40% of patients undergoing pancreaticoduodenectomy (PD) developed hepatic steatosis. However, nonalcoholic steatohepatitis (NASH) is a little-known complication after PD. Recently we encountered two patients with PD who later developed NASH diagnosed by liver biopsy. Case 1 was a 79-year-old woman who underwent PD for intraductal papillary mucinous neoplasm (IPMN). She had postoperative severe diarrhea due to pseudomembranous enterocolitis. Severe liver dysfunction was observed on the 31st postoperative day. Abdominal computed tomography (CT) on the 32nd day showed remarkably decreased hepatic CT value of 6 HU. Immediate liver biopsy revealed NASH (Brunt criteria: grade 2, stage 2). Case 2 was a 71-year-old woman who underwent PD for IPMN. Liver biopsy on 70th postoperative day, which was performed for assessment of moderate liver dysfunction and decreased hepatic CT value of 44 HU, demonstrated simple steatosis. In the 21st postoperative month, she developed severe urinary tract infection together with marked liver dysfunction. Immediate liver biopsy revealed NASH (Brunt criteria: grade 1, stage 1). For each patient, treatment of infection and highdose pancreatic enzyme supplements improved liver dysfunction and liver steatosis. Clinical features of our cases seem to support the current leading hypothesis of the pathogenesis of NASH, i.e., the two-hit theory.

Original languageEnglish
Pages (from-to)242-248
Number of pages7
JournalClinical Journal of Gastroenterology
Volume4
Issue number4
DOIs
Publication statusPublished - 08-2011
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Gastroenterology

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