Abdominal compartment syndrome as a complication of percutaneous nephrolithotomy requiring extra-corporeal life support-a case report

Background: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for staghorn renal calculus and is used in adults as well as in paediatric practice with good stone clearance. Although small amounts of irrigation fluid leaking into the retroperitoneal space is common, large fluid leak is rare and can cause abdominal compartment syndrome (ACS) leading to significant morbidity and mortality if not detected and treated in a timely fashion. Typically, early intraoperative haemodynamic or ventilatory changes should raise the suspicion of large volume irrigation fluid leak and ACS during PCNL. Case Description: We report a case of a previously fit and well 10-year-old boy who underwent PCNL and developed ACS without any warning sign which progressed to multiple organ failure and shock, that was resistant to maximal medical therapy. Extracorporeal membrane oxygenation (ECMO) was deployed to optimise organ perfusion and aid recovery of the organ functions. Conclusions: This case report highlights the fact that this lethal complication can arise silently and the combination of a high index of suspicion, a proactive approach with close monitoring, and good coordination between the anaesthetist and surgeon is the key to successful outcome. Literature pertaining to irrigation fluid leak and the use of ECMO in this context will be reviewed.