Acute hyaline necrosis of the liver: A surgical trap☆

Abstract Acute hyaline necrosis of the liver is an acute inflammatory and necrotizing process associated with alcoholism. The clinical picture presented frequently mimics a surgical hepatobiliary lesion as it did in sixteen of twentythree patients not having a portacaval shunt. An operation was performed on ten of these patients and importantly contributed to the death of four of them. A second group of twenty-three patients with acute hyaline necrosis was included among a total of fifty-four patients upon whom portacaval shunting was performed for cirrhosis and bleeding varices. There were fifteen immediate postoperative deaths and four late deaths, leaving only four patients alive one to seven years later among the twenty-three patients with hyaline necrosis. In contrast, among the thirty-one cirrhotic patients without hyaline necrosis there were only two postoperative and five late deaths, leaving twenty-four patients alive one to seven years postoperatively. Although the disease may be suspected clinically, especially if liver tenderness is present, conclusive diagnosis requires histologic examination of the liver biopsy specimen. The usual criteria for evaluating surgical risk among the patients having a portacaval shunting procedure, such as serum bilirubin, albumin, prothrombin, and presence of ascites and encephalopathy, were of no value in identifying those with acute hyaline necrosis. It is recommended that needle biopsy of the liver precede consideration for emergency or urgent operative control of bleeding varices in the patient with cirrhosis.