title: Abdominal intra-compartment syndrome - a non-hydraulic model of abdominal compartment syndrome due to post-hepatectomy hemorrhage in a man with a localized frozen abdomen due to extensive adhesions: a case report.
abstract: BACKGROUND
  Postoperative hemorrhage is a significant cause of morbidity and mortality following liver resection. It typically presents early within the postoperative period, and conservative management is possible in the majority of cases. We present a case of late post-hepatectomy hemorrhage associated with overt abdominal compartment syndrome resulting from a localized functional compartment within the abdomen.
  
  
  METHODS
  A 68-year-old white man was readmitted with sudden onset of upper abdominal pain, vomiting, and hemodynamic instability 8 days after an uneventful hepatic resection for metachronous colon cancer metastasis. A frozen abdomen with adhesions due to complicated previous abdominal surgeries was encountered at the first intervention, but the surgery itself and initial recovery were otherwise unremarkable. Prompt response to fluid resuscitation at admission was followed by a computed tomography of his abdomen that revealed active arterial hemorrhage in the liver resection site and hemoperitoneum (estimated volume <2 L). Selective arteriography successfully identified and embolized a small bleeding branch of his right hepatic artery. He remained hemodynamically stable, but eventually developed overt abdominal compartment syndrome. Surgical exploration confirmed a small volume of ascites and blood clots (1.2 L) under significant pressure in his supramesocolic region, restricted by his frozen lower abdomen, which we evacuated. Dramatic improvement in his ventilatory pressure was immediate. His abdomen was left open and a negative pressure device was placed for temporary abdominal closure. The fascia was formally closed after 48 hours. He was discharged home at postoperative day 6.
  
  
  CONCLUSIONS
  Intra-abdominal pressure and radiologic findings of intra-abdominal hemorrhage should be carefully interpreted in patients with extensive intra-abdominal adhesions. A high index of suspicion and detailed understanding of abdominal compartment mechanics are paramount for the timely diagnosis of abdominal compartment syndrome in these patients. Clinicians should be aware that abnormal anatomy (such as adhesions) coupled with localized pathophysiology (such as hemorrhage) can create a so-named abdominal intra-compartment syndrome requiring extra vigilance to diagnose.
authors.affiliation: Department of Surgery, University of Calgary and the Foothills Medical Centre, North Tower 10th Floor, 1403-29th Street Northwest, Calgary, AB, T2N 2T9, Canada.
authors.forename: Alexsander K
authors.initials: AK
authors.lastname: Bressan
authors.affiliation: Department of Surgery, University of Calgary and the Foothills Medical Centre, North Tower 10th Floor, 1403-29th Street Northwest, Calgary, AB, T2N 2T9, Canada.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Kirkpatrick
authors.affiliation: Department of Surgery, University of Calgary and the Foothills Medical Centre, North Tower 10th Floor, 1403-29th Street Northwest, Calgary, AB, T2N 2T9, Canada. Ball.Chad@gmail.com.|Departments of Surgery and Oncology, Foothills Medical Centre and the University of Calgary, 1403 - 29 Street NW, Calgary, AB, T2N 2T9, Canada. Ball.Chad@gmail.com.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
mesh_terms: D034841:Abdominal Cavity / Q000000981:diagnostic imaging* / Q000473:pathology; D015746:Abdominal Pain; D000368:Aged; D003161:Compartment Syndromes / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006498:Hepatectomy / Q000009:adverse effects*; D006499:Hepatic Artery / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D000267:Tissue Adhesions / Q000000981:diagnostic imaging* / Q000473:pathology; D016896:Treatment Outcome; D014839:Vomiting
keywords: Abdominal compartment syndrome; Abdominal compliance; Abdominal intra-compartment syndrome; Case report; Hydraulic model; Intra-abdominal hypertension; Intra-abdominal pressure