Abdominal compartment syndrome following chemotherapy-induced gastrointestinal mucositis: a case report

Abdominal compartment syndrome (ACS) is a life-threatening condition typically associated with trauma, major surgery, or acute abdominal pathology. Its occurrence in oncology patients, particularly as a complication of chemotherapy-induced gastrointestinal mucositis, is exceedingly rare. This report presents a unique case of ACS triggered by mucosal injury following chemotherapy, complicated by septic shock and multiorgan failure, in a patient with lung cancer.

A 64-year-old male with lung cancer underwent platinum-etoposide chemotherapy. Following his fourth cycle, he developed bowel dysmotility and was administered a laxative, which precipitated profuse watery diarrhea. Within hours, he experienced progressive abdominal distension, nausea, vomiting, and hemodynamic instability. Laboratory tests revealed severe metabolic acidosis, hyperlactatemia, and pancytopenia. Imaging showed massive gastrointestinal fluid retention and elevated intra-abdominal pressure (IAP). Blood cultures confirmed ESBL-producing Escherichia coli bacteremia. The patient was admitted to the intensive care unit and received mechanical ventilation, vasopressors, continuous renal replacement therapy, gastrointestinal decompression, and broad-spectrum antibiotics. IAP peaked at 28 mmHg, fulfilling criteria for ACS. With multidisciplinary management, including PiCCO-guided hemodynamic optimization and targeted antimicrobial therapy, the patient's condition gradually improved. He was extubated on day 17 and discharged from the intensive care unit on day 19.

This case illustrates a rare but critical pathway from chemotherapy-induced mucosal injury to ACS, mediated by enterogenic sepsis and systemic inflammation. Early recognition, continuous IAP monitoring, and aggressive supportive care are essential for survival. Clinicians should maintain a high index of suspicion for ACS in immunocompromised oncology patients presenting with abdominal symptoms and septic physiology.