J.Jpn. Surg. Soc.. 83(9): 1127-1131, 1982

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Report on the annual meeting

MANAGEMENT OF MULTIPLE ORGAN FAILURE AFTER DIGESTIVE SURGERY, WITH SPECIAL REFERENCE TO MOF ASSOCIATED WITH LIVER CIRRHOSIS

Multiple organ failure (MOF) might be a cause of death after major surgery in patients associated with liver cirrhosis. Of 993 cases who underwent surgery of the digestive disease, eleven cases developed MOF with significant failure of three or more critical organs or systems after surgery.
The mean age was 57.2 years, the youngest 31 and the oldest 81. Nine males and two females. All eleven patients had a significant pre-exsisting disease: liver cirrhosis in 8 cases and obstructive jaundice in 3. Eight of eleven cases (72.7%) died with the average survival of 11 days.
The etiological factors were massive blood transfusion in 3, postoperative bleeding in 3, sepsis in 3 and DIC in 2.
The earliest failed organ or system was lung and DIC in especially the cirrhotic patients.
Preoperative ICG Rmax and lipid emulsion tests were correlated well with the prognosis. Limulus test was positive with 81.8% and FDP was over 10μg/dl with 90.9% postoperatively. These suggested that reticuloendothelial function decreased in MOF cases and might be one of the important factors to develope MOF.
Therefore, it is important to estimate functional reserve of the liver, reticuloendothelial function and blood clotting mechanism preoperatively in detail and manage those patients postoperatively with intensive care for the cardio-pulmonary and renal functions.

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