Ye Bei, Miao Yang De
Department of Gastroenterology, Taizhou Municipal Hospital, Taizhou, Zhejiang, China.
Ulus Travma Acil Cerrahi Derg. 2014 Mar;20(2):136-8. doi: 10.5505/tjtes.2014.95825.
We report a case of a patient with a delayed large 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 might have led to dramatically elevated intrahepatic pressures that in turn restricted hepatic vein reflux and subsequently resulted in acute liver failure. Therefore, she underwent percutaneous drainage, and the decompression instantly reversed the liver injury. This phenomenon is similar to the well-described abdominal compartment syndrome, which is defined as new onset organ dysfunction or failure secondary to sustained intraabdominal hypertension and in which decompression is the standard treatment.
我们报告一例患者，其在肝损伤18天后出现延迟性肝内巨大血肿，血红蛋白短暂降至62 g/L。腹部计算机断层扫描显示下腔静脉严重受压变平，这与不断增大的血肿压迫相符。尽管传统上并无手术干预指征，但该患者出现了急性肝衰竭，肝酶和胆红素进行性升高。我们推测不断扩大的血肿可能导致肝内压力急剧升高，进而限制肝静脉回流，随后导致急性肝衰竭。因此，她接受了经皮引流，减压后肝损伤立即得到逆转。这种现象类似于已被充分描述的腹腔间隔室综合征，该综合征定义为继发于持续性腹腔内高压的新发器官功能障碍或衰竭，减压是其标准治疗方法。
