Clinical Case Database / Category: Clinical Care
Abdominal compartment syndrome
Saima Ehsan MBBS, Shahab Siddiqi BSc FRCS (General Surgeon)
Foundation Years Journal, volume 2, issue 7, p.332 (123Doc Education, London, September 2008)
A 30-year-old man with a BMI of 35, who had been admitted with acute pancreatitis 2 days previously, started complaining of increasing abdominal pain. On examination he was alert, oriented and apyrexial. He had a raised respiratory rate, tachycardia, low jugular venous pressure and blood pressure of 100/50. Chest examination was unremarkable. Abdominal examination demonstrated a markedly distended abdomen mildly tender in all four quadrants. Observation charts suggested at least a 4 litre positive fluid balance. Pulmonary embolus, sepsis and cardiac causes of shock seemed unlikely, so an initial diagnosis of hypovolaemic shock was made and investigations requested. Aggressive resuscitation was initiated with oxygen and intravenous fluids. On review 3 hours later, he was less alert. Respiratory rate had increased and a pulse oxymetry reading of 90% was recorded. The tachycardia had increased and blood pressure was unchanged. His abdomen had distended further and he had passed only 15 ml urine in the intervening period despite the prescribed fluids. Oxygen and fluid therapy were escalated, but the presumptive diagnosis of hypovolaemic shock seemed to be in doubt as the primary cause of decompensation as the patient was resistant to fluid resuscitation.
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Saima Ehsan MBBS
Department of Colorectal Surgery
Castle Hill Hospital
East Yorkshire HU16 5JQ
Shahab Siddiqi BSc FRCS (General Surgeon) (Corresponding author)
Department of Colorectal Surgery
Castle Hill Hospital, Cottingham
East Yorkshire HU16 5JQ
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