An Experimental Study of the So-Called Liver Death Syndrome in Biliary Surgery

Abstract

A series of experiments was undertaken with the idea of reproducing in experimental animals the clinical and postmortem findings observed in so-called “liver deaths” after biliary surgery, to which Heyd 1 first called attention. Such deaths fall into 2 distinct groups. In the first group death occurs shortly after operation, hyperpyrexia is the outstanding symptom, and degenerative liver changes are the only notable autopsy finding. In the second group death is deferred for 10 to 14 days, uremic symptoms predominate, and autopsy reveals the liver changes just described, plus similar degenerative changes in the convoluted tubules of the kidney. None of the usual surgical causes of death is apparent.

Ten sets of experiments were performed upon dogs whose renal competency was assured by detailed preoperative studies. The following experiments failed to reproduce the clinical and postmortem pictures desired:

1. Traumatic necrosis of the liver by various manual and instrumental methods. Eight dogs.

2. Various types of interference with the hepatic and portal circulation.∗ Sixteen dogs.

3. Obstruction of the biliary tree by ligation and division of the common duct, with or without cholecystectomy. Twelve dogs.

4. Intraperitoneal implantation of normal liver, as done by Andrews and Hrdina 2 and previous workers. Approximately 150 gm. of liver was implanted in each of 5 dogs.

5. Intraperitoneal injection of normal liver, as described by the same authors, who were able by this method to cause an autolytic peritonitis as in experiment 4, a finding which we could not confirm. Three dogs were used. Three hundred grams ground liver was extracted in 3,000 cc. of warm sterile water and concentrated to 17, 18.5 and 25 cc. respectively.

6. Intravenous injection of 20 cc. of extract of normal liver, extracted and concentrated in the proportion and by the method just described. One dog.