Hepatic infarction as a complication of gastric cancer surgery: report of four cases.

Four cases of patients who developed hepatic infarction caused by an operative injury to the hepatic circulation during gastric cancer surgery are reported herein. In two patients, the hepatic infarction resulted from accidental injury to the proper hepatic artery, and in the other two, it was possibly due to persistent pressure on the folded liver by a retractor during surgery. In the former two patients, the proper hepatic artery had been collapsed by the spread of enlarged metastatic lymph nodes before the onset of the arterial injury. In the latter two patients, postoperative laboratory data and computed tomography scanning revealed hepatic infarction even though preservation of the proper hepatic artery was confirmed by angiography. Elevated serum levels of hepatic enzymes released from the infarcted tissue recovered to the normal range within three weeks in all four patients. In conclusion, when an operative injury to the hepatic artery is encountered, the hepatoduodenal ligament should not be manipulated any more than necessary to preserve the collaterals, and the gallbladder should be removed to prevent necrotic perforation. Although close observation is mandatory, conservative therapy seems to be sufficient when an infarcted area is restricted to the lateral segment and a small part of the medial segment of the liver.