Missed Diagnosis of Abdominal Compartment Syndrome

This case involves a seventy-year-old woman who was treated at a  hospital for a right hip fracture, weakness, and chronic atrial fibrillation with a rapid ventricular response. Two days after she was discharged to a long-term care facility, she was readmitted for urinary retention and recurrent tachycardia. Additionally, she complained of generalized weakness and midline lower abdominal pain. The patient was stabilized from a cardiac perspective and sent home after the cardiology staff cleared her. The patient was not worked up for the abdominal pain as it was thought to be associated with the abnormal heart rhythms. Two days later, the patient was found dead in her home from what was determined to be abdominal compartment syndrome.

Question(s) For Expert Witness

  • 1. What type of treatment would have benefited this patient?

Expert Witness Response E-000736

The treatment of ACS is multifactorial and depends upon both the severity and the primary cause. Since a wide variety of patients may develop IAH/ACS, no one management strategy can be uniformly applied. Appropriate IAH/ACS management is based upon three principles: serial monitoring of IAP, optimization of systemic perfusion and organ function, and prompt surgical decompression for refractory IAH. Most patients with Grade III pressures and all patients with Grade IV pressures should have surgical decompression. Nonsurgical strategies are appropriate, at least initially, for Grades I and II. These modalities may include body positioning, nasogastric and colonic decompression, fluid resuscitation, diuretics and continuous renal replacement therapies, as well as percutaneous catheter decompression.


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