Hypoxic hepatitis, also known as ischemic hepatitis, is characterized by acute hepatocellular injury due to inadequate oxygen delivery to the liver. Celiac trunk stenosis can lead to hepatic ischemia and subsequent liver damage. We present the case of an 81-year-old patient with a history of hypertension, ischemic heart disease, hypothyroidism, and biliary lithiasis, who developed hypoxic hepatitis secondary to Dunbar syndrome and a stenosis of the superior mesenteric artery. The patient improved symptoms and liver function tests with conservative management, including intravenous fluids and supportive care. Long-term management involved continued antiplatelet therapy and statins, with consideration of further interventions for celiac trunk stenosis. This case underscores the importance of recognizing Dunbar syndrome as well as superior mesentery trunk stenosis as a potential cause of hypoxic hepatitis. It highlights the need for multidisciplinary management in such cases.
References
[1]
Fuhrmann, V., Kneidinger, N., Herkner, H., Heinz, G., Nikfardjam, M., Bojic, A., et al. (2009) Hypoxic Hepatitis: Underlying Conditions and Risk Factors for Mortality in Critically Ill Patients. Intensive Care Medicine, 35, 1397-1405. https://doi.org/10.1007/s00134-009-1508-2
[2]
Acar, G., Cicekcibasi, A.E., Koplay, M. and Seher, N. (2022) Anatomical Variations of the Celiac Trunk and Hepatic Arteries with a New Classification, Based on CT Angiography. Journal of College of Physicians and Surgeons Pakistan, 32, 9-14, https://doi.org/10.29271/jcpsp.2022.01.9
[3]
Salim, H., Ozgur, O., Erman, K., Ozturk, S., Sarikaya Dogan, M., Sindel, T., et al. (2023) Collateral Circulation Develops in Stenosis of the Celiac Trunk and Superior Mesenteric Artery. Surgical and Radiologic Anatomy, 45, 479-486. https://doi.org/10.1007/s00276-023-03104-z
[4]
Waseem, N. and Chen, P.H. (2016) Hypoxic Hepatitis: A Review and Clinical Update. Journal of Clinical and Translational Hepatology, 4, 263-268. https://doi.org/10.14218/jcth.2016.00022
[5]
Henrion, J. (2011) Hypoxic Hepatitis. Liver International, 32, 1039-1052. https://doi.org/10.1111/j.1478-3231.2011.02655.x
[6]
Soleimanpour, H., Safari, S., Rahmani, F., Nejabatian, A. and Alavian, S.M. (2015) Hepatic Shock Differential Diagnosis and Risk Factors: A Review Article. Hepatitis Monthly, 15, e27063. https://doi.org/10.5812/hepatmon.27063