PMC3134686_01
Temporal changes in serum aspartate transaminase (AST). Greater than 20 times elevation of AST level was reached at 5 hours after the operation (AST normal level = 5-55 IU/L).
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F1
Serum AST levels had shot up rapidly when checked 5 hours after the operation and then gradually came down over the next 2 days (Figure 1).
Postoperative changes in the serum levels of liver and inflammatory markers. (ALP: alkaline phosphatase; GGT: gamma glutamyltransferase; Bili: total bilirubin; CRP: C-reactive protein).
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F2
In contrast, serum levels of alkaline phosphatase, gamma-glutamyltransferase, total bilirubin, and C-reactive protein were slow to rise and fell only gradually (Figure 2).
Sequential cephalad (a) to caudad (f) noncontrast CT scan images demonstrating destruction of the left lobe of the liver with free intraparenchymal gas. In addition to a large loculus of gas, a branching linear pattern of gas with the portal radicals is seen clearly (e). Also note the absence of spleen, absence of any localized collections, inflammatory stranding in left subhepatic space along the drain placed towards the hiatus.
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F3
The CT scan did not show any obvious evidence of anastomotic leak, but demonstrated massive destruction in the left lobe of the liver with large loculations of intraparenchymal gas as well as gas in the portal radicals (Figure 3).