Korean J Transplant.  2022 Nov;36(Supple 1):S366. 10.4285/ATW2022.F-5068.

Nonsurgical treatment of abdominal compartment syndrome in a patient following living donor liver transplantation: a case report

• Erdene S
• Setevdorj O
• Badarch BI
• Batsuuri B
• Batjargal G
• Bat-Erdene B
• Zandanbazar U
• Sandag E
• Orgoi S

• KMID: 2535238
• DOI: http://doi.org/10.4285/ATW2022.F-5068

Abstract

The abdominal compartment syndrome is a condition characterized by pressure that leads to a decrease of capillary perfusion, resulting in a compromised vascular supply to abdominal organs followed by injury to the pulmonary, cardiac, and renal systems. The most frequent cause of acute compartment syndrome (ACS) is linked to traumatic injuries of both the bone and the soft tissues. However, surgery can lead to ACS due to an erroneous position of the patient, prolonged hypotension or a specific oper-ation, such as liver transplantation. An intra-abdominal pressure of >20 mmHg is clinically significant in nearly all patients, even at the relatively low intra-abdominal pressure of 1,015 mmHg significant alterations in organ function can be seen. Mesenteric blood flow reduces to 70% of normal when intra-abdominal pressure is about 20 mmHg and falls to 30% of normal at 40 mmHg. ACS evident in up to 0.7% of patients overall and in 31% of patients after orthotopic liver transplantation (OLT). OLT is associated with several factors that may lead to elevated intra-abdominal pressure such as bowel edema after portal vein clamping, ascites, and donor-recipient graft size mismatch. The currently accepted treatment for ACS is decompressive laparotomy. However, de-compressive laparotomy does not prevent death in ACS with a mortality rate of 49%. A 41-year-old woman with uncompensated cirrhosis due to hepatitis B virus, hepatitis D virus, Child-Turcotte-Pugh score 12, model for end-stage liver disease score 32. Portal Hypertension, esophageal varices grade 2, splenomegaly, mild ascites received a living-donor liver transplantation (LDLT) from her healthy husband. Body mass index was 23.0 kg/m 2 and body surface area was 1.65 m 2 (height, 156 cm; weight, 56 kg). Fresh frozen plasma, platelet, red blood cell, albumin, and Lasix used as drug treatment starting from postoperative day 7 in addition to the post LDLT standard treatment. Fluid resuscitation was reduced. No reoperations were performed. Large-volume resuscitation with crystalloids should be avoided in patients that have ACS or are at risk of having it.