Three days after damage control laparotomy for penetrating abdominal trauma, a 29-year-old man develops oliguria, worsening hypoxia and rising peak airway pressures. His abdomen is tense and the temporary abdominal closure is bulging. The single most useful next investigation to confirm the suspected diagnosis is:
- A Measurement of intravesical (bladder) pressure ✓
- B Serum lactate level
- C Echocardiography
- D CT abdomen with contrast
Explanation
The combination of a tense abdomen, oliguria, respiratory compromise with high airway pressures and haemodynamic deterioration after major laparotomy suggests abdominal compartment syndrome. Transvesical pressure measurement via the urinary catheter is the standard bedside method to quantify intra-abdominal pressure; sustained pressures above about 20 mmHg define intra-abdominal hypertension and above 25 mmHg with new organ dysfunction constitutes abdominal compartment syndrome requiring decompressive laparotomy. Transporting an unstable patient for CT is unsafe and adds no information beyond the pressure measurement.
Reference: Schwartz's Principles of Surgery, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.