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Abstract

Post-hepatectomy liver failure (PHLF) is a leading cause of morbidity and mortality following major liver resection. The development of PHLF is dependent on the volume of the remaining liver tissue and hepatocyte function. Without effective pre-operative assessment, patients with undiagnosed liver disease could be at increased risk of PHLF. We report a case of a 60 yearold male patient with PHLF secondary to undiagnosed alpha-1-antitrypsin deficiency (AATD) following major liver resection. He initially presented with acute large bowel obstruction secondary to a colorectal adenocarcinoma, which had metastasized to the liver. There was no significant past medical history apart from mild chronic obstructive pulmonary disease. After colonic surgery and liver directed neo-adjuvant chemotherapy, he underwent a laparoscopic partially extended right hepatectomy and radio-frequency ablation. Post-operatively he developed PHLF. The cause of PHLF remained unknown, prompting re- analysis of the histology, which showed evidence of AATD. He subsequently developed progressive liver dysfunction, portal hypertension and eventually an extensive parastomal bleed, which led to his death; this was ultimately due to a combination of AATD and chemotherapy. This case highlights that formal testing for AATD in all patients with a known history of chronic obstructive pulmonary disease; heavy smoking or strong family history could help prevent the development of PHLF in patients undergoing major liver resection.

Biography

Benjamin Charles Norton is currently a Junior Doctor completing his Postgraduate training at North West Thames Foundation School as part of Imperial College Healthcare Trust. He has completed his Medical degree from Peninsula College of Medicine & Dentistry in 2015 and has a 1st Class degree in biosciences from the University of Exeter. He is the Director and Founder of Pulsenotes Ltd, a multi award winning online teaching platform for undergraduate medical students.

Email: benjamin.norton@imperial.nhs.uk