Hepatic Compartment Syndrome Following Percutaneous Cholecystostomy: A Case Report
Fanny Marcaire1, François Malavieille, Virginie Pichot-Delahaye
11Department of Anesthesiology and Critical Care Medicine, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.2Department of Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
Insights
A subcapsular hematoma can cause hepatic compartment syndrome, leading to acute liver failure and shock. Early recognition and management are crucial to prevent fatal outcomes or the need for liver transplantation.
Area of Science:
- Hepatology
- Vascular Surgery
- Critical Care Medicine
Background:
- Subcapsular hematomas can lead to severe intra-abdominal complications.
- Budd-Chiari-like syndrome and hepatic compartment syndrome are rare but life-threatening conditions.
Observation:
- A 64-year-old male developed acute liver failure and shock following a subcapsular hematoma after percutaneous cholecystostomy.
- Computed tomography (CT) revealed a large hematoma compressing hepatic vessels and parenchyma, indicative of hepatic compartment syndrome.
- The patient presented with anemia, abdominal tenderness, severe hepatic cytolysis, metabolic acidosis, and hemodynamic instability.
Findings:
- Interventions included arteriography, hematoma evacuation, and embolization of hepatic arteries.
- Despite interventions, liver failure progressed, and the patient developed refractory shock and died.
- Autopsy findings confirmed vessel and parenchymal compression without active bleeding.
Implications:
- Hepatic compartment syndrome should be suspected in patients with subcapsular hematomas presenting with acute liver failure.
- Prompt diagnosis and management, potentially including emergency liver transplantation, are critical for survival.
- This case highlights the importance of recognizing and managing hepatic compartment syndrome to improve patient outcomes.
Objective:
To describe a case of hepatic subcapsular hematoma causing an acute Budd-Chiari-like syndrome, leading to hepatic compartment syndrome, which combines compression of intrahepatic vessels on CT, acute liver failure, and refractory shock.
Design:
Case report.
Setting:
Surgical ICU of a university teaching hospital.
Patient:
Single case: A 64-year-old man hospitalized for 1 month in the ICU after multiple complications following bypass surgery, under anticoagulation after a recent aortic valve replacement and without a medical history of hepatic disease, underwent a percutaneous cholecystostomy for acute calculous cholecystitis. Fifteen days later, he presented with acute anemia, abdominal tenderness, severe hepatic cytolysis, metabolic acidosis, and hemodynamic dysfunction. CT showed a voluminous subcapsular hematoma compressing the hepatic parenchyma, which appeared ischemic with a flattened right lobar portal vein and vena cava without any visible active bleeding.
Interventions:
Arteriography and evacuation of the hematoma under ultrasound guidance (while managing hemodynamic dysfunction) were preferred to surgery given the patient's instability and surgical history.
Measurements And Main Results:
Evidence of vessels and parenchymal compression with no source of bleeding was found despite removal of the cholecystostomy catheter. Two right sectorial inferior hepatic arteries were embolized. Hematoma was punctured to relieve pressure on hepatic parenchyma, retrieving 300 mL of blood. Unfortunately, liver failure worsened dramatically while patient developed refractory shock and died.
Conclusions:
Hepatic compartment syndrome must be suspected when acute liver failure occurs in patients with subcapsular hematoma. Only early management may avoid a fatal outcome or the need for an emergency liver transplantation.
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