Introduction: Abdominal compartment syndrome (ACS) is an uncommon but potentially life-threatening complication after liver transplantation that may lead to graft hypoperfusion and multiorgan dysfunction. Prompt recognition and timely intervention are essential to prevent irreversible graft injury.

Case presentation: We report the case of a 36-year-old woman who underwent liver retransplantation and developed abdominal distension, oliguria, and progressive hemodynamic deterioration within the first postoperative day. Doppler ultrasound demonstrated complete absence of portal venous flow without evidence of portal thrombosis or technical vascular complications. Intravesical pressure measurement revealed intra-abdominal hypertension (20mmHg), supporting the diagnosis of ACS-associated portal hypoperfusion. Decompressive laparotomy was performed, resulting in immediate restoration of portal flow and clinical improvement.

Conclusion: ACS should be considered a potentially reversible cause of low portal flow in the immediate postoperative period after liver transplantation. Doppler ultrasound may be used as an extra tool to diagnose complications when ACS occurs post liver transplant.