Successful interventional management of abdominal compartment syndrome caused by blunt liver injury with hemorrhagic diathesis

Abstract

We report that a case of primary abdominal compartment syndrome (ACS), caused by blunt liver injury under the oral anticoagulation therapy, was successfully treated. Transcatheter arterial embolization (TAE) was initially selected, and the bleeding point of hepatic artery was embolized with N-Butyl Cyanoacylate (NBCA). Secondary, percutaneous catheter drainage (PCD) was performed for massive hemoperitoneum. There are some reports of ACS treated with TAE. However, combination treatment of TAE with NBCA and PCD for ACS has not been reported. Even low invasive interventional procedures may improve primary ACS if the patient has hemorrhagic diathesis or coagulopathy discouraging surgeon from laparotomy.

Hepatic compartment syndrome treated with damage control surgery and transarterial embolization: A case report

“…Decompression and hemorrhage control are essential treatments for HCS. In previous reports, needle drainage or surgical decompression was performed for decompression [ 4 , [6] , [7] , [8] ], and surgical hemostasis or angioembolization was conducted for hemorrhage control [ 6 , 7 , 9 ]. However, the number of such reported cases is limited, and sufficient evidence has not been established for the management of this complicated condition.…”

“…However, several disadvantages associated with nonoperative management have been reported: risk of missed intra-abdominal 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 ].…”

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).…”