Pre-operative hepatitis in a woman treated with Chinese medicines

A 37-year-old Hong Kong Chinese female with cervical cancer was scheduled for radical hysterectomy and lymphadenectomy. Her past health was good. Pre-operatively, she was found to have a fatty liver, prolonged prothrombin time and abnormal liver function tests. Surgery was not postponed and she was anaesthetised uneventfully, using a general anaesthetic technique. The procedure lasted 4 h. Postoperatively, she developed a large pelvic haematoma and a wound infection. Her coagulation and liver function tests gradually returned to normal. No obvious medical cause for her liver dysfunction could be found. However, it emerged that she had received a 6-week course of traditional Chinese medicines prior to admission. The prescriptions contained over 60 different ingredients, some of which were known to be hepatotoxic, cytotoxic or to cause bleeding. This was the most likely explanation for her liver dysfunction.