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[Acute venous liver circulatory disorder caused by blunt abdominal trauma: is it a compartment syndrome?]
1Chirurgische Klinik, Medizinischen Universität Albert Szent-Györgyi, Szeged.
Authors describe the case of a 37-year-old female patient who had been operated on for a subcapsular haematoma of the liver that had developed following a blunt abdominal trauma. This manifested as a Budd-Chiari syndrome-like phenomenon that was not recognized until an exploratory operation was performed, when we found that the liver was hard and dark purple in colour and there was considerable ascites in the abdominal cavity. After aspiration of the haematoma, which contained about 1 l of a mixture of fluid and clotted blood, the circulation of the liver rapidly improved. On the basis of the findings, a posttraumatic Budd-Chiari syndrome seems unlikely, since the symptoms caused by the rise in intracapsular pressure are similar to those of a compartment syndrome. No literature data can be found to define such a posttraumatic failure of the liver circulation. Subcapsular and intrahepatic haematomata can be successfully monitored by ultrasonography and managed conservatively if they are asymptomatic. Operation is restricted to lesions with worsening symptoms or increasing danger of haemorrhage.
Authors describe the case of a 37-year-old female patient who had been operated on for a subcapsular haematoma of the liver that had developed following a blunt abdominal trauma. This manifested as a Budd-Chiari syndrome-like phenomenon that was not recognized until an exploratory operation was performed, when we found that the liver was hard and dark purple in colour and there was considerable ascites in the abdominal cavity. After aspiration of the haematoma, which contained about 1 l of a mixture of fluid and clotted blood, the circulation of the liver rapidly improved. On the basis of the findings, a posttraumatic Budd-Chiari syndrome seems unlikely, since the symptoms caused by the rise in intracapsular pressure are similar to those of a compartment syndrome. No literature data can be found to define such a posttraumatic failure of the liver circulation. Subcapsular and intrahepatic haematomata can be successfully monitored by ultrasonography and managed conservatively if they are asymptomatic. Operation is restricted to lesions with worsening symptoms or increasing danger of haemorrhage.