Acute liver failure secondary to hepatic compartment syndrome: case report and literature review

We reported a patient of delayed huge intrahepatic hematoma and transient decline in hemoglobin to 62 g/L 18 days after liver injury. Abdominal computed tomography revealed seriously flattening of inferior vena cava, which was consistent with compression by the enlarging hematoma. Although traditionally there was no indication for surgical intervention, the patient developed acute liver failure with a progressive increase in liver enzymes and bilirubin. We postulated the ever-expanding hematoma may have led to dramatically elevated intrahepatic pressures that in turn restricted hepatic vein reflux and subsequently acute liver failure. Therefore, she underwent percutaneous drainage and the decompression instantly reversed the liver injury. This phenomenon is similar with the well-described abdominal compartment syndrome, which is defined as new onset organ dysfunction or failure secondary to sustained intraabdominal hypertension and decompression is the standard treatment.