Abdominal Compartment Syndrome with Intestinal Necrosis, caused by Perforation of Diverticulosis of the Sigmoid Colon

Hideki Aragane, Satoshi Inada, Hitoshi Yasui, Keitaro Kan and Masahiro Shimizu

Department of Surgery, Aiseikai Yamashina Hospital

A 63-year-old woman diagnosed with sigmoid diverticulum perforation, underwent intraabdominal irrigation and sigmoid colostomy. Despite septic shock intraoperatively, no increase in intraabdominal pressure was apparent at closure of the abdominal wall. After large-volume fluid therapy and continuous hemodiafiltration, elevated peak airway pressure was recognized and intrabladder pressure measured at 30 mmHg on postoperative day 5. Abdominal compartment syndrome was diagnosed, necessitating emergency surgery. Segmental necrosis was seen at flexures of the ileum, so the ileum was transected 150 cm orally and the ascending colon was transected in half. Both stumps were used to form ileostomy and colostomy. The abdominal wall was opened and conventional vacuum packs applied. On POD 5 after reoperation, intestinal edema decreased together with intraabdominal pressure. Following resuturing of the abdominal wall, her general condition gradually improved and she was discharged 15 months later. Bowel necrosis following abdominal compartment syndrome is lethal, and elevated intraabdominal pressure must be detected as early as possible. We found monitoring of peak airway pressure under respirator control to be useful in detecting this condition early.

Key words
abdominal compartment syndrome, peak airway pressure, intestinal necrosis

Reprint requests
Hideki Aragane Department of Surgery, Aiseikai Yamashina Hospital
19-4 Takehana Shichono-cho, Yamashina-ku, Kyoto, 607-8086 JAPAN

Accepted
April 25, 2007

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