| Abstract: Abdominal Compartment Syndrome is a life-threatening complication of surgery and trauma. Increasing intra-abdominal pressures produce increased peak inspiratory pressures (PIP), and decreasing renal blood flow amongst other complications early in the pressure rise. Left untreated increased intracranial pressures and decreased venous return to the heart can occur. Drainage of blood from the abdomen, temporary abdominal closure with a sterile IV bag (Bogota’ bag) and Vacuum-assisted closure have all been reported as management tools for this condition. Some complex injuries may require a multi-modal approach. Such a case is presented below.
On March 28, 2004 a 27 year old female auto passenger was injured after the auto was struck on the passenger side. Initial evaluation revealed a grade 4 laceration of the liver, with active bleeding, as well as a pancreatic injury. The liver injury was managed with interventional radiological placement of coils, and the bleeding ceased, with much blood in the abdomen. Intra-abdominal pressure (IAP) was monitored, and by 3/31/2004 the pressure had risen to 30, while the urine output had fallen off, the creatinine had risen to 1.4, and PIP was up to 50. A paracentesis of 3600 ml of blood dropped the IAP to 5, the PIP fell to 37 and by the next morning urine output was normal and creatinine was down to 1.1. However, the IAP rose steadily to 21 by 4/1/2004. Another drainage catheter was placed and left in the right gutter. By 4/2/2004 another 2420 ml of fluid had drained and IAP remained low. However, a repeat CT scan questioned the possibility of extravasation of barium and she underwent exploratory surgery that day, and a walled off perforation of the jejunum was repaired. The abdomen was left open with a “Bogota‘ bag” in place.
By 4/5/2004 the IAP had risen to 23, and repeat exploration with abdominal washout and a new “Bogota‘ bag” was placed. IAP again fell to 10-15. By the next morning the IAP was up to 19. That day, at the bedside the “Bogota” bag was removed and a vacuum-assisted closure device was placed on the wound. IAP fell to 4. Her IAP was never a problem again and her serum creatinine has remained normal.
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