2 Table 1: Laboratory values of the patients described in Case 1 and Case 2 before and after administration of oxaliplatin-based neoadjuvant chemotherapy. Case 1 Case 2 Before Ctx After Ctx Before Ctx After Ctx Alkaline phosphatase (U/L) γ-glutamyltransferase (U/L) ASAT (U/L) ALAT (U/L) Bilirubin (total) (μmol/L) INR 205 50 n.a. n.a. n.a. n.a. 237 42 59 23 39 n.a. 328 233 61 91 12 n.a. 205 90 79 57 21 n.a. Ctx: chemotherapy; ASAT: aspartate aminotransferase; ALAT: alanine aminotransferase; INR: international standardized ratio; n.a.: not available did not reveal any signs of cirrhosis, portal hyperten- sion, parenchymal abnormalities, or other liver pathology. Liver function tests prior to and after administration of chemotherapy are depicted in Table 1. CT images showed a partial response of the CLMs with metastases remaining in segments IVb, VI, and VIII for which an extended right hemihepatectomy was the only realistic curative treatment. As a remnant liver volume of only 18% was calculated by CT volumetry, preoperative right portal vein embolization was performed. Five weeks later, remnant liver volume increased up to 28% which was regarded just suﬃcient for safe hemihepatectomy. An extended right hemihepatectomy with Roux-Y reconstruction was performed as detailed previously [7]. A bluish appear- ance of the liver was noticed intra-operatively without signs of portal hypertension. Histologic examination of the liver specimen showed sinusoidal congestion and nodula- rity characteristic of NRH. The postoperative course was uncomplicated till day four. From then on, bilirubin and prothrombin time increased reﬂecting post-resectional liver failure. Acute upper gastrointestinal haemorrhage occurred on day eight for which early management consisted of emer- gent endoscopy that showed bleeding from grade IV gastro- oesophageal varices. A CT scan performed on the same day showed impressive portacaval collateral shunting in the splanchnic area (see Figure 1). Unfortunately, haemorrhage recurred several hours later and second endoscopy failed to control it. Therefore, a Sengstaken-Blakemore tube was inserted and a laparotomy was performed during which the stomach was packed. Because of ongoing deterioration, a distal splenorenal shunt was created one day later to relieve portal pressure. Despite these eﬀorts, the patient died several hours after relaparotomy because of multiorgan failure secondary to haemorrhagic shock. Postmortem evaluation revealed NRH of the liver combined with hepatic congestion and infarction as well as extensive collateral vessels in the splanchnic region. There was no evidence for surgery- related technical failure like portal or hepatic vein obstruc- tion. Case Reports in Medicine ∗ ∗ ∗ Figure 1: Contrast-enhanced computed tomography scan per- formed 8 days postoperatively (Case 1). The stomach (white arrow) is ﬁlled with blood after upper gastrointestinal bleeding from gastro-oesophageal varices secondary to portal hypertension. Multiple large collateral veins run along the stomach and spleen (white asterisk). Case 2. A 51-year-old man consulted our hospital because of synchronous CLMs after sigmoid resection for colorectal carcinoma (pT3N0M1) elsewhere. The patient received six cycles of oxaliplatin (130 mg/m2) and capecitabine (1000 mg/m2 2-times daily) subsequent to resection of his primary tumour. There was no history of liver disease. The evolution of the liver function tests of the patient described in this case is shown in Table 1. CT imaging showed tumour regression after chemotherapy with metas- tases remaining in segments III, IVa and the right hemiliver. A right hemihepatectomy with metastasectomy of tumour from segments III and IVa was performed without biliary reconstruction [7]. Remnant liver volume was estimated intraoperatively to be 35% with a bluish appearance of the liver remnant. Histologic examination of the liver specimen showed a nodular appearance with hepatic congestion characteristic of NRH (Figures 2 and 3). The postoperative course was complicated by bile leakage treated by CT- guided percutaneous drainage and ERCP-guided common bile duct stenting. Bilirubin and prothrombin time decreased during admission and the patient was discharged 14 days postoperatively. Two days after discharge, the patient was readmitted in his hometown hospital because of portal hypertension leading to oesophageal variceal bleeding with hepatic encephalopathy treated by endoscopic band ligation and conservative measures, respectively. Laboratory values normalized steadily consistent with an improvement of the patient’s clinical and mental status. Full recovery was accomplished after two months. One year afterwards, the patient presented himself with multiple recurrent CLMs in segments II and III for which he received 3 cycles of irinotecan (300 mg/m2) prior to liver surgery. Preoperative diagnostic liver biopsy showed minimal nodularity and steatosis without indications for NRH or steatohepatitis. The patient underwent treatment of