Massive hepatic necrosis following portacaval shunt. Report of two cases and considerations of liver hemodynamics after shunt

Complications of portacaval-shunt procedure are many and varied. In two cases of a hitherto undescribed complication, massive "anoxic pseudolobular necrosis" of the hepatic parenchyma developed immediately following side-to-side procedures. Factors other than the anastomosis (gastrointestinal bleeding and shock) were operative in one of the cases, but no explanation other than hemodynamic alterations in the liver following the shunt procedure were found in the second case. Although previously unreported, earlier stages of this complication may be the basis for many of the immediate postoperative deaths labeled "hepatic coma" or "hepatic failure" by different authors.