This OR operations case involves a fifty-eight-year-old female patient who presented to the ER complaining of multiple episodes of daily, non-bilious, non-bloody vomiting, along with generalized abdominal pain. The patient was diagnosed with an intestinal obstruction and was taken to the operating room, where a sigmoidal mass was identified to be obstructing the entire lumen of the bowel. A hemicolectomy with colostomy and mobilization of hepatic flexure was performed. One week after surgery, the patient developed abdominal compartment syndrome and was brought back to the operating room for exploration. The patient sustained a cardiac event on the operating table and CPR was conducted. The patient remained ventilator dependent secondary to respiratory failure, along with acute renal failure that necessitated peritoneal dialysis. The patient never regained consciousness following the exploratory abdominal procedure and the family decided to withdraw supportive care after two weeks.
Question(s) For Expert Witness
- 1. What is the general prognosis for abdominal compartment syndrome?
Expert Witness Response E-001738
If left untreated for an extended time, abdominal compartment syndrome is almost uniformly fatal. Eddy and colleagues documented a mortality rate of 68% for patients with documented abdominal compartment syndrome seen from 1984-1996. Most of the population was male (70%), and most had experienced blunt trauma (80%). In the subsequent literature, mortality rates have ranged from 25%-75%. The high mortality in abdominal compartment syndrome, even with treatment, reflects the fact that the condition affects multiple organ systems. Furthermore, abdominal compartment syndrome is often a sequelae to severe injuries that independently carry a high morbidity and high mortality.