Abdominal Compartment Syndrome in an Open Abdomen: Case Report and Literature Review

1St. Mary's Medical Center, San Francisco, CA

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 225

Case Presentation:

This 65‐year‐old man was transferred to the intensive care unit for acute shock on postoperative day 1 s/p laparotomy for ventral hernia mesh repair. Rapid intravenous fluid resuscitation was initiated, and central venous pressure (CVP) monitoring showed values from 10 to 16 mm Hg. The surgeon took the patienl back to the operating theater because of suspected intra‐abdominal hypertension (IAH). The bowels appeared well perfused, and Ihe decision was made to place a vacuum‐assisted closure (VAC) device in order to apply negative‐pressure wound therapy and create an “open” abdomen. The patient returned to the ICU with the wound VAC in place with 50 mm Hg of negative pressure applied. He remained hemodynamically stable for 3 hours but again went into shock. His CVP continued in the 12‐18 mm Hg range, so a femoral arterial catheter was placed to measure pulse pressure variation (PPV) to guide fluid resuscitation. Vasopressor agents were added because PPV was less than 13%. Despite the wound VAC, we suspected the patient was suffering from abdominal compartment syndrome (ACS). Intra‐abdominal pressure (IAP) was measured by attaching a pressure transducer to the luer‐lock on the Foley catheter, clamping the drainage lube, and instilling 50 mL of sterile saline into the bladder. IAP was measured at 36 mm Hg. Within hours of surgery, his lactate increased from 2.8 to 19.1 mmol/L, LDH increased from 471 to 10,190 units/L, and AST/ALT increased from 23/22 to 10,227/2149 units/L. The diagnosis of small bowel infarction secondary tc abdominal compartment syndrome was made, and the family consented to withdrawal of supportive measures. Small bowel necrosis was confirmed at autopsy.

Discussion:

Abdominal compartment syndrome is associated with high morbidity and mortality and is prevalent yet underrecognized in medical ICUs. Using IAP cutoffs of 10 and 20 mm Hg, Malbrain et aL have reported the prevalence of IAH and ACS as 54.4% and 10.5%, respectively. Studies have demonstrated that physical exam is only 60% sensitive for detecting IAH/ACS; thus, accurate and reproducible monitoring is vital for early detection, management, and consideration of surgical decompression. This case demonstrates that management of an open abdomen with a wound VAC device does not obviate the recurrence of abdominal compartment syndrome.

Conclusions:

This case discussion highlights the importance of early recognition of IAH/ACS in an “;open”; abdomen. An up‐to‐date literature review and simple monitoring technique are provided.

Author Disclosure:

P. Bui, none.

To cite this abstract:

Bui P. Abdominal Compartment Syndrome in an Open Abdomen: Case Report and Literature Review. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 225. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/abdominal-compartment-syndrome-in-an-open-abdomen-case-report-and-literature-review/. Accessed August 24, 2019.

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