2023 Military Poster Presentations

John L Fletcher, MD1; Sarah Thomas, MD2; Thomas Alicea, RT2; Christina Riojas, MD2; Emily Hathaway, MD2; Timothy Nunez, MD2; 1Oregon Health & Science University; 2Brooke Army Medical Center

Objective: Blunt liver injury is increasingly managed non-operatively in modern trauma centers. Hepatic compartment syndrome is a rare and poorly described clinical entity seen most commonly following percutaneous liver biopsy. Herein we report the first case of post-traumatic hepatic compartment syndrome and its operative management.

Methods: A review of patient presentation, diagnosis, management and outcomes were performed in a retrospective fashion.

Results: A 29 year-old man sustained an isolated Grade IV blunt liver injury without capsular rupture after a fall from height. On admission transcatheter embolization of active intrahepatic hemorrhage was performed.  Within 24 hours of admission gross hematuria and acute oliguric renal failure developed. Bedside ultrasound identified complete occlusion of the retrohepatic inferior vena cava (IVC) and cessation of renal venous outflow. No direct renal injuries were identified. These findings are consistent with hepatic compartment syndrome.  The patient was taken emergently to the operating room for decompression of the liver with the intent of restoring venous outflow from the infrahepatic IVC.  Following decompression and evacuation of approximately 1 liter of clot and blood from the hepatic capsule antegrade flow in the IVC was restored.  Despite restoration of antegrade caval blood flow oliguric renal failure persisted and renal replacement therapy was required for 32 days. His course was also by complicated acute liver failure which was successfully medically managed.  He was ultimately discharged on hospital day 53 having achieved complete renal and hepatic recovery. 

Conclusion: Hepatic compartment syndrome is a rare but severe complication of blunt liver injury. Optimal management strategies for post-traumatic hepatic compartment syndrome are unknown.  Surgical decompression may have a role in the management of post-traumatic hepatic compartment syndrome but its timing and overall utility remain unclear.