Ischemic hepatitis secondary to hepatic artery steal in a patient with celiac artery stenosis and severe postural hypotension

Ischemic hepatitis, also known as hypoxic hepatitis or shock liver is defined as an acute, transient elevation of aminotransferase levels in the absence of any known causes. The pathogenesis is multifactorial. Many studies have suggested systemic hypotension as a major contributor to the pathogenesis of ischemic hepatitis but that alone is not enough to cause it. Celiac artery stenosis does not commonly cause clinically significant hepatic ischemia because of its rich collaterals. We present a case of a 78‐year‐old male with a background of severe orthostatic hypotension, who presented with elevation of liver enzymes due to hepatic artery steal precipitated by celiac artery stenosis. Clinical investigations showed elevated transaminases and unremarkable CT scan. Invasive celiac artery angiography showed a critical ostial lesion and it was stented. The liver enzymes peaked the day following stenting and normalized over the next 9 days. This confirmed clinically significant hepatic artery steal due to an ostial celiac artery stenosis. Relieving the celiac artery stenosis normalized the liver enzymes confirming the interdependence of the two components of this rare syndrome. Our report is the only report to our knowledge where classic hepatic artery steal and shock liver was demonstrated due to the rare combination of severe orthostatic hypotension and celiac artery ostial stenosis. © 2011 Wiley‐Liss, Inc.