Acute ischemic hepatitis in aortocaval fistula

Objectives. To characterise liver dysfunction in patients with aortocaval fistula. Design. Retrospective study. Materials. All four patients operated on for aortocaval fistula between 1999 and 2003. Three were males with ruptured abdominal aortic aneurysm (AAA). One was a female who underwent lumbar disk surgery. Four patients operated on for ruptured AAA were used as controls. Methods. Measurement Of serum aspartate aminotransferase (AST), alanine amino transferase (ALT), lactate dehydrogenase (LDH) and creatinine from the preoperative period until full recovery. Results. The median delay between the presumed formation of the fistula and surgery was 2 days (range 1-3 days). High levels of AST, ALT and LDH were observed in all patients, starting from the preoperative period, reaching the maximum on the first two postoperative days and normalising thereafter. Median peak values were: AST=4256 IU/l (range 816-7779), ALT=2487 IU/l (range 960-5645) and LDH=15165 IU/l (range 3122-32361). Serum creatinine also sustained alterations with a similar time course. Median peak values were: 256 mumol/l (range 230-468). All the patients survived. Conclusions. Acute ischemic hepatitis appears to be a consistent or, at least, a common complication of aortocaval fistula. Although a concern during the perioperative period, its course is benign and fully resolves upon successful surgery.