Hypoxic hepatitis during the perioperative period in patients with severe pulmonary disease and cor pulmonale

Hypoxic hepatitis (HH) is characterized by marked and transient elevations in liver enzyme levels in the absence of other potential causes of liver injury. Although rare, it can occur in the presence of hemodynamic instability and hypoxemia in patients with cor pulmonale. We report two cases of perioperative HH in patients with severe pulmonary disease and cor pulmonale. The first case is of a patient with cor pulmonale who underwent hemiarthroplasty for a femur fracture. Transient hypotension developed during spinal anesthesia and severe hypoxemia were observed in the postoperative period. After surgery, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels suddenly increased to 3740 and 817 U/L, respectively. The second case is of a patient with congestive heart failure and cor pulmonale whose blood pressure and oxygen saturation decreased during induction of general anesthesia and after surgery, and AST, ALT, and lactic dehydrogenase levels increased to 1291, 1292, and 2710 U/L, respectively. The liver enzyme levels normalized within 7–14 days in both cases. We speculate the diagnosis of these cases as HH.