A 30-year-old man with blunt abdominal trauma and multiple injuries becomes progressively oliguric despite adequate resuscitation. Peak inspiratory pressure on the ventilator is climbing, and his abdomen is tense and distended. Bladder pressure measured transurethrally is 26 mmHg. What is the definitive management?

• A Intravenous furosemide bolus
• B Decompressive midline laparotomy ✓
• C Nasogastric decompression and rectal tube
• D Continuous venovenous haemofiltration

Explanation

An intra-abdominal pressure above 20 mmHg with new organ dysfunction, here oliguria and rising airway pressures, defines abdominal compartment syndrome. The only definitive treatment is decompressive midline laparotomy, which immediately relieves the pressure on renal veins, the diaphragm and visceral perfusion. Diuretics worsen hypovolaemia, bowel decompression alone cannot lower intra-abdominal pressure sufficiently in this setting, and dialysis treats uraemia but not the mechanical compression causing the organ failure.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.