Fujita Motoo, Sato Takeaki, Takase Kei, Sato Tomomi, Furukawa Hajime, Kushimoto Shigeki
Department of Emergency and Critical Care Medicine, Tohoku University Hospital Emergency Center, Sendai-shi 980-8574, Japan.
Department of Diagnostic Radiology, Tohoku University Hospital, Sendai-shi 980-8574, Japan.
Trauma Case Rep. 2023 May 30;46:100857. doi: 10.1016/j.tcr.2023.100857. eCollection 2023 Aug.
Hepatic compartment syndrome (HCS) is a complication of nonoperative management in patients with blunt hepatic injury. Although decompression of elevated intrahepatic pressure through surgical exploration or drainage and hemorrhage control are required to manage this condition, evidence for such a management for this complication is insufficient. Herein, we report a pediatric patient treated with a planned combination strategy of surgical decompression with perihepatic packing to reduce intrahepatic pressure and subcapsular hemorrhage control as well as angioembolization to control intraparenchymal hemorrhage.
A 12-year-old boy was referred to our emergency department 5 h after sustaining severe bruising in the upper abdomen in a traffic accident. Computed tomography (CT) showed an intraparenchymal hematoma in the right lobe of the liver; nonoperative management was selected based on stable hemodynamic status. Two days after the injury, he complained of severe abdominal pain and shock. CT showed an intraparenchymal and large subcapsular hematoma with right branch compression of the portal vein and extravasation of contrast material. Laboratory data showed progression of hepatocellular damage. We successfully managed this patient with a planned combination strategy of surgical decompression with perihepatic packing for reduction of intrahepatic pressure and subcapsular hemorrhage control, followed by angioembolization for control of intraparenchymal hemorrhage.
Our study suggests that for the management of HCS, a planned combination strategy of damage control surgery and angioembolization is a therapeutic option.
肝包膜下综合征（HCS）是钝性肝损伤患者非手术治疗的一种并发症。虽然需要通过手术探查或引流以及控制出血来降低肝内压力，但针对这种并发症的此类治疗证据不足。在此，我们报告一例儿科患者，采用了计划性联合策略，即通过肝周填塞进行手术减压以降低肝内压力并控制包膜下出血，同时进行血管栓塞以控制实质内出血。
一名12岁男孩在交通事故中腹部上部遭受严重挫伤5小时后被转诊至我院急诊科。计算机断层扫描（CT）显示肝脏右叶实质内血肿；基于血流动力学稳定选择了非手术治疗。受伤两天后，他主诉严重腹痛和休克。CT显示实质内和巨大的包膜下血肿，门静脉右支受压且造影剂外渗。实验室数据显示肝细胞损伤进展。我们通过计划性联合策略成功治疗了该患者，即先通过肝周填塞进行手术减压以降低肝内压力并控制包膜下出血，随后进行血管栓塞以控制实质内出血。
我们的研究表明，对于肝包膜下综合征的治疗，损伤控制手术和血管栓塞的计划性联合策略是一种治疗选择。
