Clin Endosc.  2014 Sep;47(5):469-472. 10.5946/ce.2014.47.5.469.

Abdominal Compartment Syndrome in Severe Acute Pancreatitis Treated with Percutaneous Catheter Drainage

• Park S
• Lee S
• Lee HD
• Kim M
• Kim K
• Jeong Y
• Park SM

• KMID: 2165383
• DOI: http://doi.org/10.5946/ce.2014.47.5.469

Abstract

Acute pancreatitis is one of the main causes of intra-abdominal hypertension (IAH). IAH contributes to multiple physiologic alterations and leads to the development of abdominal compartment syndrome (ACS) that induces multiorgan failure. We report a case of ACS in a patient with severe acute pancreatitis. A 44-year-old man who was admitted in a drunk state was found to have severe acute pancreatitis. During management with fluid resuscitation in an intensive care unit, drowsy mentality, respiratory acidosis, shock requiring inotropes, and oliguria developed in the patient, with his abdomen tensely distended. With a presumptive diagnosis of ACS, abdominal decompression through percutaneous catheter drainage was performed immediately. The intraperitoneal pressure measured with a drainage catheter was 31 mm Hg. After abdominal decompression, the multiorgan failure was reversed. We present a case of ACS managed with percutaneous catheter decompression.

Keyword

Severe acute pancreatitis; Intra-abdominal hypertension; Percutaneous catheter drainage

MeSH Terms

Abdomen
Acidosis, Respiratory
Adult
Catheters*
Decompression
Diagnosis
Drainage*
Humans
Intensive Care Units
Intra-Abdominal Hypertension*
Lower Body Negative Pressure
Oliguria
Pancreatitis*
Resuscitation
Shock
Transcutaneous Electric Nerve Stimulation

Figure

• 

  Fig. 1 Abdominal computed tomography findings. (A, axial view; B, coronal view) Peripancreatic fat infiltration and fluid collection in the pelvic cavity were observed on admission. (C, axial view; D, coronal view) A swollen pancreas with peripancreatic fluid collection, marked bowel edema (arrows), and ascites were observed on the 12th hospital day. (E, axial view; F, coronal view) After abdominal decompression, fluid collection decreased in the peritoneum; however, colonic wall thickening (arrow) remained on the 17th hospital day.

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  Fig. 2 Chest radiograph findings. (A) Acute respiratory distress syndrome (ARDS) developed on the 3rd hospital day. (B) ARDS worsened on the 12th hospital day. (C) After abdominal decompression, ARDS improved on the 17th hospital day.

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  Fig. 3 Percutaneous catheter drainage at four sites of the peritoneum.

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  Fig. 4 After abdominal decompression by using percutaneous cystic drainage, the patient's intra-abdominal pressure was decreased. Consequently, respiratory acidosis, oliguria, and confused mental status resolved. HU, hour urine; IAP, intra-abdominal pressure.

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