Hu H, Liu YJ, Li MC, Li Y, Lin SD. Rapid progression to liver failure following pancreatoduodenectomy in an adolescent: A case report. World J Gastroenterol 2026; 32(29): 120498 [DOI: 10.3748/wjg.120498]
Corresponding Author of This Article
Shi-De Lin, MD, Chief Physician, Professor, Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, No. 201 Dalian Street, Zunyi 563003, Guizhou Province, China. linshide6@zmu.edu.cn
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Gastroenterology & Hepatology
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case-report
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Hu H, Liu YJ, Li MC, Li Y, Lin SD. Rapid progression to liver failure following pancreatoduodenectomy in an adolescent: A case report. World J Gastroenterol 2026; 32(29): 120498 [DOI: 10.3748/wjg.120498]
World J Gastroenterol. Aug 7, 2026; 32(29): 120498 Published online Aug 7, 2026. doi: 10.3748/wjg.120498
Rapid progression to liver failure following pancreatoduodenectomy in an adolescent: A case report
Han Hu, Yu-Juan Liu, Mei-Chuan Li, Yan Li, Shi-De Lin
Han Hu, Yu-Juan Liu, Mei-Chuan Li, Shi-De Lin, Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
Yan Li, Department of Hygiene Toxicology, School of Public Health, Zunyi Medical University, Zunyi 563003, Guizhou Province, China
Author contributions: Hu H and Liu YJ contributed to manuscript writing, editing, and data collection; Li MC contributed to data analysis; Li Y and Lin SD contributed to conceptualization and supervision; and all authors have read and approved the final manuscript.
AI contribution statement: AI tools were used exclusively for language refinement and did not contribute to study design, data acquisition, data analysis, interpretation of results, figure preparation, or reference selection. The authors take full responsibility for the scientific accuracy, integrity, and originality of the manuscript.
Supported by the Science and Technology Research Foundation of Zunyi City, No. ZSKH-HZ[2023] 222; and the Guizhou Provincial Science and Technology Program, No. QKHJC-ZK[2024] 315.
Informed consent statement: Written informed consent for the use of the data for clinical research purposes was obtained from the patient’s mother. Authors’ institution does not require ethical approval for publication of a single case report.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Shi-De Lin, MD, Chief Physician, Professor, Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, No. 201 Dalian Street, Zunyi 563003, Guizhou Province, China. linshide6@zmu.edu.cn
Received: February 28, 2026 Revised: April 28, 2026 Accepted: June 8, 2026 Published online: August 7, 2026 Processing time: 139 Days and 9.1 Hours
Abstract
BACKGROUND
Pancreatoduodenectomy (PD) is a major surgical intervention that frequently leads to pancreatic exocrine insufficiency and subsequent malnutrition. A recognized but often indolent complication in adults is the development of malnutrition-associated steatohepatitis. While rare instances of progression to cirrhosis have been reported in adults, the trajectory of post-PD hepatic complications in pediatric and adolescent populations remains largely uncharacterized. This population’s unique physiological demands for growth and development may predispose them to more aggressive disease phenotypes.
CASE SUMMARY
We present the case of a 14-year-old male patient who underwent a pylorus-preserving PD in July 2019 for a benign solid-cystic lesion of the pancreatic head. The postoperative course was complicated by severe pancreatic exocrine insufficiency, manifesting as intractable steatorrhea and profound, progressive malnutrition, which was less effectively controlled possibly due to both insufficient enzyme replacement and poor adherence to pancreatic enzyme replacement therapy. Four years after surgery (June 2023), he developed hepatic steatosis that rapidly progressed to decompensated cirrhosis with portal hypertension. Despite aggressive nutritional rehabilitation and optimized pancreatic enzyme replacement therapy, his clinical condition continued to decline. He was readmitted in March 2025 with acute-on-chronic liver failure, culminating in multi-organ failure and death in April 2025, less than six years after his initial surgery. This case represents a rarely documented instance of fatal, rapidly progressive malnutrition-associated steatohepatitis leading to liver failure in an adolescent following PD.
CONCLUSION
Adolescent patients can progress to cirrhosis and liver failure post-pylorus-preserving PD, necessitating intensified dynamic monitoring of nutritional status and liver function.
Core Tip: This report describes a 14-year-old male patient who developed cirrhosis and liver failure after pylorus-preserving pancreatoduodenectomy. Despite pancreatic enzyme replacement therapy, the patient experienced long-term refractory steatorrhea, severe malnutrition, and trace element deficiencies. Malnutrition-associated steatohepatitis and decompensated cirrhosis occurred 4 years postoperatively, followed by progression to liver failure and death from multi-organ dysfunction 2 years later. This case highlights that adolescent patients post-pylorus-preserving pancreatoduodenectomy, due to developmental growth demands, have specific and stringent requirements for pancreatic enzyme replacement and nutritional management. Inadequate management can lead to rapid, fatal progression to cirrhosis and liver failure.
