Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Hepatic compartment syndrome, a rare complication after any liver insult or liver transplantation: Three case reports and literature review

  • Alexandra Nassar (Department of HPB Surgery and Liver Transplantation, APHP.Nord, Beaujon Hospital) ;
  • Theo Braquet (Department of HPB Surgery and Liver Transplantation, APHP.Nord, Beaujon Hospital) ;
  • Beatrice Aussilhou (Department of HPB Surgery and Liver Transplantation, APHP.Nord, Beaujon Hospital) ;
  • Maxime Ronot (Department of Radiology, APHP.Nord, Beaujon Hospital) ;
  • Emmanuel Weiss (Universite Paris Cite) ;
  • Federica Dondero (Department of HPB Surgery and Liver Transplantation, APHP.Nord, Beaujon Hospital) ;
  • Mickael Lesurtel (Department of HPB Surgery and Liver Transplantation, APHP.Nord, Beaujon Hospital) ;
  • Safi Dokmak (Department of HPB Surgery and Liver Transplantation, APHP.Nord, Beaujon Hospital)
  • Received : 2024.02.16
  • Accepted : 2024.03.25
  • Published : 2024.08.31
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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.

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References

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