Ann Hepatobiliary Pancreat Surg.  2024 Aug;28(3):283-290. 10.14701/ahbps.24-040.

Hepatic compartment syndrome, a rare complication after any liver insult or liver transplantation: Three case reports and literature review

• Nassar A
• Braquet T
• Aussilhou B
• Ronot M
• Weiss E
• Dondéro F
• Lesurtel M
• Dokmak S

• KMID: 2558662
• DOI: http://doi.org/10.14701/ahbps.24-040

Abstract

Hepatic compartment syndrome (HCS) is a rare but life-threatening entity that consists of a decreased portal flow due to intraparenchymal hypertension secondary to subcapsular liver hematoma. Lethal liver failure can be observed. We report three cases, and review the literature. A 54-year-old male was admitted for extensive hepatic subcapsular hematoma after blunt abdominal trauma. Initially, he underwent embolization of the hepatic artery’s right branch, after which he presented clinical deterioration, major cytolysis (310 times the upper limit of normal [ULN]), and liver failure with a prothrombin time (PT) at 31.0%. A 56-year-old male underwent liver transplantation for acute alcoholic hepatitis. On postoperative day 2, he presented a hemorrhagic shock associated with deterioration of liver function (cytolysis 21 ULN, PT 39.0%) due to extensive hepatic subcapsular hematoma. A 59-year-old male presented a hepatic subcapsular hematoma five days after a cholecystectomy, revealed by abdominal pain with liver dysfunction (cytolysis 10 ULN, PT 63.0%). All patients ultimately underwent urgent surgery for liver capsule excision, hematoma evacuation, and liver packing, if needed. The international literature was screened for this entity. These three patients’ outcomes were favorable, and all were alive at postoperative day 90. The literature review found 15 reported cases. HCS can occur after any direct or indirect liver trauma. Surgical decompression is the main treatment, and there is probably no place for arterial embolization, which may increase the risk of liver necrosis. A 13.3% mortality rate is reported. HCS is a rare complication of subcapsular liver hematoma that compresses the liver parenchyma, and leads to liver failure. Urgent surgical decompression is needed.

Keyword

Hepatic compartment syndrome; Liver injury; Liver trauma; Liver transplantation; Subcapsular liver hematoma

Figure

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  Fig. 1 (A, B) CT showing the subcapsular hematoma without parenchymal injury with active subcapsular bleeding (arrow). (C) The arteriography showing multiple peripheral blushes (arrows). (D) CT few hours after embolization showing complete necrosis of the right lobe and non-visualization of the portal flow. CT, computed tomography.

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  Fig. 2 (A) Intraoperative view showing the subcapsular hematoma (yellow arrow) and the liver capsula (white arrow). (B) The aspect after complete evacuation of the hematoma and resection of the capsula. No injury in the liver parenchyma was noted. (C) Computed tomography at 2 months showed good recovery of the right liver with peristent small foci of necrosis and hypertrophy of the left liver.

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  Fig. 3 (A) CT at postoperative day 2 showing subcapsular hematoma with compression of liver parenchyma and of the right hepatic vein. (B, C) Intraoperative view showing the hematoma and ruptured liver capsula. (D) Aspect after liver capsula resection and hemostasis. We can note the absence of parenchymal injury. (E) CT at one month showing good recovery of the right liver parenchyma. CT, computed tomography.

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  Fig. 4 (A) CT showing a subcapsular hematoma with compression of the liver parenchyma. (B) Intraoperative view showing the aspect after liver capsula resection and liver packing (black arrow). (C) CT at postoperative day 5 showing good recovery of the right liver parenchyma. CT, computed tomography.

Reference

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