Abdominal compartment syndrome: the importance of urinary catheter placement in measuring intra-abdominal pressure

Description  

A 27-year-old man with a background of alcohol excess presented to the surgical assessment unit (SAU) with abdominal pain. On clinical examination, he was tender in his epigastric and left-upper quadrant. The blood results of note were a white cell count of 21x10⁹/L, C reactive protein 332 mg/L and amylase 812 U/L. He deteriorated quite quickly on the SAU with agitation, type 1 respiratory failure and hypotension. He required intubation and ventilation, and to be started on vasopressors. A CT of his abdomen and pelvis showed features in keeping with necrotising pancreatitis with a collection in the lesser sac (figure 1). He was managed conservatively in the intensive care unit with vasopressors, intravenous fluids, nasogastric feeds and antimicrobials.

Figure 1

CT scan of abdomen and pelvis showing features of necrotising pancreatitis.

On day 2, he developed increasing abdominal distension. His intra-abdominal pressure...

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