A 60-year-old woman has a right hemi-hepatectomy for invasive cholangio-carcinoma. She has been admitted to your unit for postoperative care.

On day 6 she has a massive melaena requiring urgent endoscopy in the Intensive Care Unit. She requires endotracheal intubation. 

d)        Subsequent laparotomy reveals an infective erosion of the hepatic artery, which is grafted.  She is now developing multiple organ failure. Describe your management.

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College Answer

The ‘usual’ management of MSOF may be discussed here, but this is a woman with a limited outlook before these complications occurred (5% 5 year survival). Discussion of outlook with the patient (if possible), immediate family as well as the referring surgeon should be entered into, and of ‘how far’ therapy should go or whether it should be limited or even withdrawn should also be discussed by the candidates.