A Case with Abdominal Compartment Syndrome Saved by Damage Control after the Operation for Severe Peritonitis due to Traumatic Gastric Rupture

Yoshihiro Moriwaki, Hitoshi Inari, Takayuki Kosuge and Mitsugi Sugiyama

Critical Care and Emergency Center, Yokohama City University Medical Center

A 24-year-old man with severe peritonitis due to traumatic splenic and gastric rupture was saved by emergency decompression laparotomy after refractory shock, abdominal compartment syndrome (ACS), cardiac arrest, and disruption of the suture line for gastric rupture by cardipulmonary resuscitation. Because resuture or resection and synchronous reconstruction was thought to be difficult, we conducted peritoneal lavage, drainage, and temporary abdominal closure with sealed continuous high-pressure aspiration based on damage control (DC). After correcting metabolic dysfunction in the ICU, we conducted permanent abdominal closure by planned reoperation on postoperative day 3. We should consider ACS in patients with severe peritonitis with shock as a lethal factor and should pay attention to intra urinary-bladder pressure, respiratory and circulatory condition, and urination. Only rapid decompression laparotomy based on damage control can save these patients. Although DC is abnormal strategy following insufficient surgical management only preparing for correction of metabolic crisis in ICU, it is necessary and useful and we should be prepared to implement this strategy under all emergency conditions.

Key words
abdominal compartment syndrome, damage control, temporaly abdominal closure

Reprint requests
Yoshihiro Moriwaki Critical Care and Emergency Center, Yokohama City University Medical Center
4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024 JAPAN

Accepted
September 27, 2006

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