A 45-year-old man, day 3 after emergency laparotomy for faecal peritonitis, develops increasing ventilatory requirements, oliguria, and tense distension of the abdomen. Bladder pressure measured via the urinary catheter is 26 mmHg. What is the most appropriate management?

• A Continue conservative management with nasogastric decompression and diuretics
• B Urgent decompressive re-laparotomy with temporary abdominal closure ✓
• C Increase positive end expiratory pressure to improve oxygenation
• D Percutaneous drainage of any intra-abdominal collection under ultrasound guidance

Explanation

Abdominal compartment syndrome is defined as an intra-abdominal pressure above 20 mmHg accompanied by new organ dysfunction, here respiratory failure and oliguria. Raised pressure reduces venous return, elevates airway pressures, and impairs renal perfusion. The only definitive treatment is surgical decompression of the abdomen, usually leaving it temporarily closed with a vacuum dressing or Bogota bag until the oedema settles. Diuretics and PEEP worsen the physiology, and percutaneous drainage alone cannot relieve diffuse visceral oedema.

Reference: Schwartz's Principles of Surgery, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.