Secondary abdominal compartment syndrome in a patient with isolated extraperitoneal injuries

The abdominal compartment syndrome (ACS) is defined as increased intra-abdominal pressure (IAP) associated with adverse physiologic consequences. The ACS is most commonly diagnosed in patients sustaining abdominal or pelvic trauma, or suffering some other intra-abdominal hemorrhagic catastrophe. Recently, several groups have reported cases in which patients sustaining extra-abdominal trauma developed ACS following acute resuscitation with crystalloids or blood. This secondary ACS (SACS) appears to be related to resuscitation-induced bowel edema and ascites. SACS is a poorly understood and characterized syndrome where the increased intra-abdominal pressure occurs without abdominal injury. Timely diagnosis is difficult because of its low incidence and major trauma to other body regions. We report a fatal case of SACS, which progressed to necrotic and gangrenous large bowel.