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Nassar A, Braquet T, Aussilhou B, Ronot M, Weiss E, Dondéro F, Lesurtel M, Dokmak S. Hepatic compartment syndrome, a rare complication after any liver insult or liver transplantation: Three case reports and literature review. Ann Hepatobiliary Pancreat Surg 2024; 28:283-290. [PMID: 38867651 PMCID: PMC11341880 DOI: 10.14701/ahbps.24-040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 06/14/2024] Open
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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Affiliation(s)
- Alexandra Nassar
- Department of HPB Surgery and Liver Transplantation, APHP.Nord, Beaujon Hospital, DMU DIGEST, Clichy, France
| | - Théo Braquet
- Department of HPB Surgery and Liver Transplantation, APHP.Nord, Beaujon Hospital, DMU DIGEST, Clichy, France
| | - Béatrice Aussilhou
- Department of HPB Surgery and Liver Transplantation, APHP.Nord, Beaujon Hospital, DMU DIGEST, Clichy, France
| | - Maxime Ronot
- Department of Radiology, APHP.Nord, Beaujon Hospital, Clichy, France
- Université Paris Cité, Paris, France
| | - Emmanuel Weiss
- Université Paris Cité, Paris, France
- Department of Anesthesia-Reanimation, APHP.Nord, Beaujon Hospital, Clichy, France
| | - Federica Dondéro
- Department of HPB Surgery and Liver Transplantation, APHP.Nord, Beaujon Hospital, DMU DIGEST, Clichy, France
| | - Mickael Lesurtel
- Department of HPB Surgery and Liver Transplantation, APHP.Nord, Beaujon Hospital, DMU DIGEST, Clichy, France
- Université Paris Cité, Paris, France
| | - Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, APHP.Nord, Beaujon Hospital, DMU DIGEST, Clichy, France
- Université Paris Cité, Paris, France
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Onishi Y, Shimizu H, Oka S, Taniguchi T, Kawahara S, Ishisaka Y, Isoda H, Nakamoto Y. Transcatheter arterial embolization for subcapsular hematoma of the liver. Abdom Radiol (NY) 2023; 48:765-772. [PMID: 36378282 DOI: 10.1007/s00261-022-03732-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/25/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aimed to evaluate the technical and clinical success rates of transcatheter arterial embolization (TAE) for subcapsular hematoma of the liver. METHODS Between January 2010 and March 2022, 34 patients underwent TAE for subcapsular hematomas of the liver. The causes of subcapsular hematoma were liver tumor rupture (n = 12), trauma (n = 12), iatrogenic complications (n = 9), and spontaneous bleeding (n = 1). The technical and clinical success rates of TAE, blood test results after TAE and additional treatments were evaluated. The patients were divided into either with or without retrograde segmental or lobar portal venous flow on angiography. Technical and clinical success rates and blood test results after TAE were compared between the two groups. RESULTS Technical and clinical success rates were 94.1% and 73.5%, respectively. Six patients died within one month of TAE. A repeat TAE was performed in three patients. Surgical removal and hemostasis for subcapsular hematoma were done in four patients. One patient had liver failure. The retrograde portal venous flow was observed in 18 patients. The difference in technical and clinical success rates and blood test results after TAE between the two groups was statistically insignificant. CONCLUSION TAE is an effective and safe treatment for subcapsular hematomas of the liver. The success rates of TAE and liver damage due to TAE did not differ between patients with and without retrograde portal venous flow.
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Affiliation(s)
- Yasuyuki Onishi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Hironori Shimizu
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shojiro Oka
- Department of Diagnostic Radiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Seiya Kawahara
- Department of Radiology, Otsu Red Cross Hospital, Otsu, Japan
| | - Yukio Ishisaka
- Department of Diagnostic Radiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hiroyoshi Isoda
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Lee HN, Cho SG, Lee WH. Interventional Management of Subcapsular Hepatic Hematoma with Hepatic Compartment Syndrome After Laparoscopic Adrenalectomy. Cardiovasc Intervent Radiol 2019; 42:625-628. [PMID: 30603970 DOI: 10.1007/s00270-018-02158-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 12/26/2018] [Indexed: 10/27/2022]
Abstract
Hepatic compartment syndrome is an increase in intrahepatic pressure sufficient to cause compromised hepatic perfusion. Early recognition and prompt management are essential for preventing catastrophic consequences including ischemic liver failure and hypovolemic shock. This is the rare case of laparoscopic adrenalectomy resulting in subcapsular hepatic hematoma with hepatic compartment syndrome. Contrast-enhanced computed tomography demonstrated extensive subcapsular hepatic hematoma with collapse of portal vein and inferior vena cava suggesting impending compartment syndrome. Diagnostical catheter angiography of the liver revealed innumerable foci of petechial extravasation from disrupted isolated arteries. Emergent percutaneous catheter decompression and transarterial embolization were successful.
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Affiliation(s)
- Hyoung Nam Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan-si, Republic of Korea.
| | - Sung Gi Cho
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woong Hee Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan-si, Republic of Korea
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Yoshida K, Matsui O, Miyayama S, Ibukuro K, Yoneda N, Inoue D, Kozaka K, Minami T, Koda W, Gabata T. Isolated Arteries Originating from the Intrahepatic Arteries: Anatomy, Function, and Importance in Intervention. J Vasc Interv Radiol 2018; 29:531-537.e1. [PMID: 29477620 DOI: 10.1016/j.jvir.2017.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 02/07/2023] Open
Abstract
Isolated hepatic arteries are defined as hepatic terminal arterioles that are not accompanied by portal venules or bile ductules and penetrate the liver parenchyma and distribute to the hepatic capsule and intrahepatic hepatic veins. Abundant communications exist between intra- and extrahepatic arteries through isolated arteries and capsular arterial plexus. They play a principal role in the development of subcapsular hemorrhage and arterial collateral formation following transcatheter arterial chemoembolization for liver cancers. The anatomy, function, and clinical importance of isolated hepatic arteries in interventional radiology, especially regarding subcapsular hemorrhage and arterial collateral formation, are highlighted in this article.
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Affiliation(s)
- Kotaro Yoshida
- Department of Radiology, Kanazawa University School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Osamu Matsui
- Department of Radiology, Kanazawa University School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Shiro Miyayama
- Department of Diagnostic Radiology, Fukui-ken Saiseikai Hospital, Fukui City, Fukui, Japan
| | - Kenji Ibukuro
- Department of Radiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Norihide Yoneda
- Department of Radiology, Kanazawa University School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Dai Inoue
- Department of Radiology, Kanazawa University School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kazuto Kozaka
- Department of Radiology, Kanazawa University School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tetsuya Minami
- Department of Radiology, Kanazawa University School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Wataru Koda
- Department of Radiology, Kanazawa University School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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