Clin Mol Hepatol.  2012 Dec;18(4):404-410. 10.3350/cmh.2012.18.4.404.

Severe steatohepatitis with hepatic decompensation resulting from malnutrition after pancreaticoduodenectomy

• Sim EH
• Kwon JH
• Kim SY
• Jung SM
• Maeng LS
• Jang JW
• Chung KW

• KMID: 1410898
• DOI: http://doi.org/10.3350/cmh.2012.18.4.404

Abstract

The most common finding related to nonalcoholic steatohepatitis is obesity, but a status of severe malnutrition can also induce the steatohepatitis. The authors report a rare case of steatohepatitis leading to hepatic decompensation caused by malnutrition after pancreaticoduodenectomy. A 68-year-old female patient who had been previously diagnosed with pancreatic cancer and had undergone pancreaticoduodenectomy 5 months previously presented with abdominal distension. Routine CT performed 3 months after the surgery revealed severe fatty liver without evidence of tumor recurrence. After undergoing pancreaticoduodenectomy her food intake had reduced, and as a result she had lost 7 kg of body weight over 2 months. At this admission, CT revealed moderate amounts of ascites without tumor recurrence. Furthermore, her albumin and lipid profile levels were markedly decreased, and she had a flapping tremor and slurred speech suggestive of hepatic encephalopathy. Her liver biopsy findings were consistent with steatohepatitis and disclosed macrovesicular steatosis without definite fibrosis. After careful nutritional control, her symptoms disappeared and her laboratory findings improved.

Keyword

Nonalcoholic steatohepatitis; Malnutrition; Pancreaticoduodenectomy; Pancreatic cancer; Hepatic decompensation

MeSH Terms

Aged
Ascites/etiology
Fatty Liver/*diagnosis/etiology/pathology
Female
Humans
Liver Function Tests
Malnutrition/*complications
Pancreatic Neoplasms/surgery
Pancreaticoduodenectomy
Tomography, X-Ray Computed