Fatal Abdominal Compartment Syndrome Due to Constipation: A Case Report

Area of Science:

• Medicine
• Gastroenterology
• Critical Care

Background:

• Abdominal compartment syndrome (ACS) is a life-threatening condition characterized by increased intra-abdominal pressure leading to organ dysfunction.
• Early recognition and diagnosis, often via bladder pressure measurement, are crucial for improving patient outcomes.
• Causes of ACS are diverse, necessitating a broad differential diagnosis.

Purpose of the Study:

• To highlight severe constipation as a rare but critical cause of abdominal compartment syndrome.
• To underscore the challenges in managing ACS secondary to constipation due to limited evidence-based guidelines.
• To emphasize the importance of early recognition and prompt management strategies for this specific patient population.

Main Methods:

• Case report of a 64-year-old female patient presenting with symptoms of severe constipation and abdominal distension.
• Utilized computed tomography (CT) to assess abdominal anatomy, including colonic dilation, inferior vena cava status, and organ perfusion.
• Documented the patient's clinical course, including resuscitative measures and outcome following attempted surgical decompression.

Main Results:

• The patient presented with a severely distended abdomen due to a dilated, stool-filled colon, indicative of extreme constipation.
• Imaging revealed decreased organ perfusion, a hallmark of ACS.
• Despite resuscitative efforts and surgical decompression, the patient's outcome was unfavorable, highlighting the severity and complexity of this condition.

Conclusions:

• Severe constipation is an uncommon yet significant etiology of abdominal compartment syndrome.
• There is a critical need for evidence-based guidelines to manage ACS specifically when caused by severe constipation.
• While hemodynamic and respiratory support are initial steps, surgical decompression remains the definitive treatment, emphasizing the imperative for early diagnosis and intervention.