Acute liver failure secondary to hepatic compartment syndrome: case report and literature review

Abstract

We report a case of a patient with a delayed large intrahepatic hematoma and transient decline in hemoglobin to 62 g/L 18 days after liver injury. Abdominal computed tomography revealed seriously flattening of inferior vena cava, which was consistent with compression by the enlarging hematoma. Although traditionally there was no indication for surgical intervention, the patient developed acute liver failure with a progressive increase in liver enzymes and bilirubin. We postulated the ever-expanding hematoma might have led to dramatically elevated intrahepatic pressures that in turn restricted hepatic vein reflux and subsequently resulted in acute liver failure. Therefore, she underwent percutaneous drainage, and the decompression instantly reversed the liver injury. This phenomenon is similar to the well-described abdominal compartment syndrome, which is defined as new onset organ dysfunction or failure secondary to sustained intraabdominal hypertension and in which decompression is the standard treatment.

Hepatic Compartment Syndrome Following Percutaneous Cholecystostomy

“…If the patient is hemodynamically unstable, exploratory laparotomy with evacuation of the hematoma and conventional hemostasis techniques should be proposed, with perihepatic packing if bleeding persists (4,(16)(17)(18)(19). Hepatic angiography Critical Care Medicine www.ccmjournal.org e177 before and after image-guided aspiration of the hematoma in order to locate an eventual bleeding source to embolize represents another strategy, especially for stable patients or if open surgery is considered too risky (3,16). It may, however, not be sufficient, especially in case of clotting of the hematoma preventing aspiration.…”

“…Proposed therapeutic algorithm for management of hepatic compartment syndrome (from ref [2,3,4,16,17,19]…”

“…We report a case of subcapsular hematoma which occurred a few days after mobilization of a percutaneous cholecystostomy (PC) catheter causing hepatic parenchymal compression and resulting in acute liver failure. We therefore diagnosed a "hepatic compartment syndrome," because of its similarities with the mechanisms of abdominal compartment syndrome (2)(3)(4). Authorization for publication by the patient family was obtained.…”

The Role of Endovascular Intervention in Post Liver Hemorrhagic Blunt Trauma

“…19 According to the new guidelines for the management of blunt liver trauma, laparotomy is only indicated if the patient is hemodynamically unstable and has signs of peritonitis. 19,20 Surgical and nonsurgical (e.g., endovascular intervention) management have the same recovery objectives in trauma cases, which are reducing massive bleeding and saving lives. 13 The complications from blunt liver trauma include hepatic artery pseudoaneurysms, which have a high risk for rupture and hemorrhage.…”

Hepatic Compartment Syndrome Treated with Damage Control Surgery and Transarterial Embolization: A Case Report

“…However, several disadvantages associated with nonoperative management have been reported: risk of missed intraabdominal injury; transfusion-related illness; and risks associated with embolization techniques including hepatic necrosis, abscess formation, and bile leak (3). Reports have found that intrahepatic or subcapsular hematoma can increase intrahepatic pressure, excluding the portal vein and inferior vena cava, resulting in marked hepatic dysfunction and obstructive shock in patients with hepatic injury who were treated nonoperatively (4)(5)(6)(7)(8). This pathological condition has been described as hepatic compartment syndrome (HCS) and is most commonly reported in young patients with hard hepatic capsules (9).…”