A patient undergoing damage control laparotomy with temporary abdominal closure develops progressive abdominal distension, rising peak airway pressures, oliguria, and worsening acidosis on postoperative day 2. Bladder pressure measured transurethrally is 26 mmHg. The most appropriate next step is:

• A Increase sedation and neuromuscular blockade and reassess in 12 hours
• B Aggressive loop diuretic therapy to reduce visceral oedema
• C Urgent surgical decompression of the abdomen ✓
• D Large volume paracentesis through the wound

Explanation

Intra-abdominal hypertension progresses to abdominal compartment syndrome when intra-abdominal pressure exceeds approximately 20 to 25 mmHg with new organ dysfunction. The findings here, elevated airway pressures, oliguria, and metabolic deterioration, constitute established organ failure. Definitive treatment is surgical decompression of the abdomen. Diuresis is contraindicated in this shocked state, and temporising measures alone risk irreversible ischaemic organ loss.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.