Abdominal Compartment Syndrome with Obstructive Shock Treated byDecompressive Laparotomy in the Emergency Room

Abstract

Obstructive shock is a clinical condition requiring quick diagnosis and treatment. However, it is not known whether the abdominal compartment syndrome (ACS) can cause obstructive shock. A 79-year-old man complaining of abdominal pain was brought to our hospital by ambulance; his respiratory status was poor and blood pressure was low. Physical examination revealed abdominal distention, and computed tomography showed marked dilatation of the small intestine and collapse of the inferior vena cava. The patient was diagnosed as having ACS associated with intestinal obstruction; decompressive laparotomy was performed in the emergency room, after which his breathing and blood pressure dramatically improved. No necrosis of any intestinal segment was observed. Adhesion was determined as the cause of the intestinal obstruction. ACS refers to a sustained increase of the intra-abdominal pressure, resulting in obstructive shock. In that case, ACS meeds decompressive laparotomy. The ACS was treated by decompressive laparotomy. However, intra-abdominal pressure measurement is difficult after a sudden change of the patient's condition, complicating the diagnosis. Moreover, intra-abdominal pressure is not measured in approximately half of the patients with ACS in Japan. Therefore, the appropriate time for laparotomy should be determined by measuring the intra-abdominal pressure regularly in patients at risk of development of ACS.