A polytrauma patient 48 hours after damage control laparotomy has a tense distended abdomen, oliguria refractory to fluids, rising airway pressures on ventilation and increasing lactate. Bladder pressure measured transurethrally is 26 mmHg. The most appropriate management is:

• A Increase sedation and neuromuscular blockade
• B Decompressive laparotomy with temporary abdominal closure ✓
• C Percutaneous decompression of the stomach and colon
• D Diuretics plus fluid bolus to maintain urine output

Explanation

Abdominal compartment syndrome is defined as an intra-abdominal pressure above 20 mmHg together with new end-organ dysfunction such as oliguria, raised ventilatory pressures and lactate-driven acidosis. Medical measures including sedation, paralysis and gastric decompression may lower pressure modestly in borderline cases, but established ACS causing organ failure demands urgent surgical decompression, since mortality rises steeply with delay. Bladder pressure is the accepted bedside surrogate for intra-abdominal pressure.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.