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CASE REPORTS  
CMH 2012 December;18:404-410.
Published online 2012 December 24. doi:http://dx.doi.org/10.3350/cmh.2012.18.4.404
Copyright © 2012 The Korean Association for the Study of the Liver
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Severe steatohepatitis with hepatic decompensation resulting from malnutrition after pancreaticoduodenectomy
Eun Hui Sim1, Jung Hyun Kwon1, Se Young Kim1, Seung Min Jung1, Lee-So Maeng2, Jeong Won Jang1, and Kyu Won Chung1
1Department of Internal Medicine and 2Department of Hospital Pathology, Incheon St. Marys hospital, The Catholic University of Korea College of Medicine, Incheon, Korea
Corresponding Author: Jung Hyun Kwon ,Tel: +82-32-280-5020, Fax: +82-32-280-5987, Email: doctorkwon@catholic.ac.kr
ABSTRACT
The most common finding related to nonalcoholic steatohepatitis is obesity, but a status of severe malnutrition can also induce the steatohepatitis. The authors report a rare case of steatohepatitis leading to hepatic decompensation caused by malnutrition after pancreaticoduodenectomy. A 68-year-old female patient who had been previously diagnosed with pancreatic cancer and had undergone pancreaticoduodenectomy 5 months previously presented with abdominal distension. Routine CT performed 3 months after the surgery revealed severe fatty liver without evidence of tumor recurrence. After undergoing pancreaticoduodenectomy her food intake had reduced, and as a result she had lost 7 kg of body weight over 2 months. At this admission, CT revealed moderate amounts of ascites without tumor recurrence. Furthermore, her albumin and lipid profile levels were markedly decreased, and she had a flapping tremor and slurred speech suggestive of hepatic encephalopathy. Her liver biopsy findings were consistent with steatohepatitis and disclosed macrovesicular steatosis without definite fibrosis. After careful nutritional control, her symptoms disappeared and her laboratory findings improved.
Keywords: Nonalcoholic steatohepatitis; Malnutrition; Pancreaticoduodenectomy; Pancreatic cancer; Hepatic decompensation
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