Case Report: Nonoperative management of traumatic dual-vessel hepatic infarction

Hepatic infarction is localized hepatocyte necrosis caused by loss of arterial or portal blood flow; dual-supply infarction, involving simultaneous occlusion of both, is exceedingly rare and typically iatrogenic. Patients commonly present with abdominal pain, nausea, and marked transaminitis, often progressing to hemorrhage or sepsis. In postpartum women, symptom overlap with hepatic disorders such as HELLP syndrome may delay diagnosis. Here, we present a woman in her thirties, three weeks post-cesarean section, who developed dual-supply infarction of the left lobe after sustaining blunt abdominal trauma. Diagnosis was confirmed radiologically, and she was managed nonoperatively with close monitoring, correction of coagulopathy, and early anticoagulation. Liver enzymes normalized and follow-up imaging showed complete resolution. This represents the first documented case of dual occlusion of both inflow vessels following blunt abdominal trauma in a postpartum patient, in addition to the first documented instance of hepatic lobe atrophy with contralateral hypertrophy following traumatic devascularization alone. This case highlights that carefully selected anticoagulation can preclude the need for surgical intervention, even in traumatic dual-supply hepatic infarction.