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Alan D. Proia, MD; Bernard F. Fetter, MD; Brett H. Woodard, MD; Delford L. Stickel, MD; William C. Meyers, MD

Arch Surg. 1986;121(10):1206-1208.

Abstract
• A 52-year-old man died during reoperation for bleeding after the development of acute postoperative acalculous cholecystitis. While the liver was being manipulated during surgery, the pulmonary artery diastolic pressure increased suddenly, cardiac output and blood pressure decreased, and soon afterward the patient had a cardiac arrest from which he could not be resuscitated. During resuscitative efforts, the maximum partial arterial oxygen pressure achieved was only 55 mm Hg despite 100% inspired oxygen. At autopsy, bile aggregates were found within necrotic liver parenchyma, portal and central vein branches, and numerous pulmonary arterioles and capillaries. The pulmonary arterial bile most likely resulted from embolization of inspissated hepatic bile aggregates during surgical manipulation.

(Arch Surg 1986;121:1206-1208)

Author Affiliations
From the Departments of Pathology (Drs Proia, Fetter, and Woodard) and Surgery (Drs Stickel and Meyers), Duke University Medical Center, Durham, NC.

Footnotes
Accepted for publication Oct 31, 1985.

Reprint requests to Department of Surgery, Box 3041, Duke University Medical Center, Durham, NC 27710 (Dr Meyers).

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