Recovery from Fulminant Hepatic Failure and Prolonged Deep Coma without Liver Transplantation

Katsuhisa OMAGARI; Daisuke NORIMURA; Hiroyuki YAJIMA; Yoshiko KADOKAWA; Ken-ichi TAKAMORI; Maki YOSHIMURA; Osamu YOSHITOMI; Toshiaki NAKAMURA; Takuji MAEKAWA; Sungsam CHO; Tetsuji MAKITA; Yukio KAMOHARA; Toshiro YOSHIMURA; Jun-ichi MASUDA; Yohei MIZUTA; Shigeru KOHNO

doi:10.11343/amn.49.153

CASE REPORTS

Recovery from Fulminant Hepatic Failure and Prolonged Deep Coma without Liver Transplantation

Katsuhisa OMAGARI, Daisuke NORIMURA, Hiroyuki YAJIMA, Yoshiko KADOKAWA, Ken-ichi TAKAMORI, Maki YOSHIMURA, Osamu YOSHITOMI, Toshiaki NAKAMURA, Takuji MAEKAWA, Sungsam CHO, Tetsuji MAKITA, Yukio KAMOHARA, Toshiro YOSHIMURA, Jun-ichi MASUDA, Yohei MIZUTA, Shigeru KOHNO

Author information

Katsuhisa OMAGARI
Second Department of Internal Medicine, Nagasaki University School of Medicine
Daisuke NORIMURA
Second Department of Internal Medicine, Nagasaki University School of Medicine
Hiroyuki YAJIMA
Second Department of Internal Medicine, Nagasaki University School of Medicine
Yoshiko KADOKAWA
Second Department of Internal Medicine, Nagasaki University School of Medicine
Ken-ichi TAKAMORI
Second Department of Internal Medicine, Nagasaki University School of Medicine
Maki YOSHIMURA
Intensive Care Unit, Nagasaki University Hospital
Osamu YOSHITOMI
Intensive Care Unit, Nagasaki University Hospital
Toshiaki NAKAMURA
Intensive Care Unit, Nagasaki University Hospital
Takuji MAEKAWA
Intensive Care Unit, Nagasaki University Hospital
Sungsam CHO
Intensive Care Unit, Nagasaki University Hospital
Tetsuji MAKITA
Intensive Care Unit, Nagasaki University Hospital
Yukio KAMOHARA
Department of Transplantation and Digestive Surgery, Nagasaki University Graduate School of Biomedical Sciences
Toshiro YOSHIMURA
Nagasaki University School of Health Sciences
Jun-ichi MASUDA
Department of Internal Medicine, Nagasaki Municipal Medical Center
Yohei MIZUTA
Second Department of Internal Medicine, Nagasaki University School of Medicine
Shigeru KOHNO
Second Department of Internal Medicine, Nagasaki University School of Medicine

Keywords: Fulminant hepatic failure, Hepatic coma, Liver transplantation, Electroencephalography, Hepatitis B virus

JOURNAL FREE ACCESS

2004 Volume 49 Issue 4 Pages 153-157

DOI https://doi.org/10.11343/amn.49.153

Details

Abstract

The overall mortality of fulminant hepatic failure without liver transplantation is around 70%. However, the most critical problem in the management of fulminant hepatic failure is the indication of liver transplantation because this disease is sometimes reversible without such treatment. We encountered a 27-year old patient with acute type fulminant hepatic failure and deep coma (grade V hepatic encephalopathy). Electroencephalography showed generalized low voltage activity in all leads, but cranial computed tomography revealed no diffuse brain edema. The patient was treated with artificial liver support without liver transplantation, and finally recovered without any neurological deficits. The indications for liver transplantation in patients with deep coma are still controversial because the reversibility of severe coma cannot be accurately predicted before the transplantation. Therefore, more data are needed for the correct therapeutic management (with or without liver transplantation) of fulminant hepatic failure.

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