Clinical Case Database / Category: Clinical Care

Abdominal compartment syndrome

Publication details

Saima Ehsan MBBS, Shahab Siddiqi BSc FRCS (General Surgeon)
Foundation Years Journal, volume 2, issue 7, p.332 (123Doc Education, London, September 2008)

Abstract

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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Authors

Saima Ehsan MBBS

FTSTA2
Department of Colorectal Surgery
Castle Hill Hospital
Cottingham
East Yorkshire HU16 5JQ

Shahab Siddiqi BSc FRCS (General Surgeon) (Corresponding author)

Fellow
Department of Colorectal Surgery
Castle Hill Hospital, Cottingham
East Yorkshire HU16 5JQ
shahab@doctors.org.uk

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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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