INTRODUCTIONRhabdomyolysis (RML) is a condition characterized by the acute or subacute necrosis and breakdown of muscle tissue, resulting in the destruction of skeletal muscle cell membranes and the release of cellular contents into the bloodstream[1] . The typical clinical manifestations include myalgia (observed in 23% of patients), muscle weakness (observed in 12% of patients), and dark urine (observed in 10% of patients). However, the majority of patients present with atypical clinical symptoms and solely exhibit myalgia, which may result in a missed diagnosis[2] . The causes of RML are diverse, including trauma, substance abuse, metabolic disorders, alcohol and infection. Especially in critically ill patients, the occurrence of rhabdomyolysis is insidious and fatal.Acute hepatic failure is severe liver damage caused by multiple factors, resulting in severe dysfunction or decompensation of synthetic, detoxifying, metabolic and biotransforming functions. Here we report the therapeutic process of a young male patient with acute traumatic hepatic failure who suffered from RML and leading to severe compartment syndrome during hospitalization.CASE PRESENTATION A 20-year-old young male patient experienced abdominal pain and distension due to the impact of the robotic arm. Abdominal CT confirmed that the patient suffered from acute liver rupture and had massive hemoperitoneum. We promptly conducted an exploratory laparotomy on the patient, during which we removed the damaged liver and performed meticulous hemostasis. The patient continued to exhibit postoperative confusion and intermittent lethargy. However, there was a progressive deterioration in the patient’s liver function. We actively provide symptomatic supportive treatment, while also using artificial liver support therapy. On the 6th day of hospitalization, the patient suffered from acute hemorrhagic shock again, with a heart rate of 160-170bpm, blood pressure of 80/40 mmHg, hemoglobin of 50.00 g/L, and urine output reduced to 30ml/h. The patient underwent another exploratory laparotomy and partial hepatectomy, but remained in critical condition with postoperative liver failure. On the 11th day of hospitalization, the patient underwent orthotopic liver transplantation. After surgery, he received hormonal sequential anti-rejection therapy and immunosuppressive therapy, and the patient’s liver function gradually restored.After undergoing liver transplantation, the patient developed acute kidney injury, with obvious pitting edema in both lower limbs and anuria. We performed blood purification and closely monitored changes in renal function and urine output. Intermittent plasma exchange was performed to eliminate macromolecular substances and protected renal function. The patient’s bilateral lower limb edema symptoms relieved after treatment. On the 4th day after liver transplantation surgery, the patient complained of limited dorsiflexion of both ankle joints. Further physical examination revealed that the patient’s bilateral hip and knee flexion strength was grade 2, and the ankle dorsal extensor strength was grade 1. Ultrasound examination showed normal blood perfusion in the lower limbs, while decreased sensation in both lower limbs. On the 10th day after surgery, the patient experienced severe pain in both lower legs, accompanied by squeezing pain. The pressure of the intermuscular compartment of both lower legs increased significantly (Figure 1A). The ultrasonic manifestations of lower limbs musculature were thickening, reduction of ultrasonic echo intensity and blurred muscle texture (Figure 1B). And the blood perfusion in the lower limbs is normal. Magnetic resonance imaging (MRI) of the lower back and lower limbs showed muscular edema and peri-muscular effusion (Figure 1C & D).