Abdominal compartment syndrome after robotic-assisted thoracoscopic surgery (RATS) diaphragm plication

Diaphragm plication is an effective treatment for diaphragmatic paralysis, in which the affected diaphragm is sutured in place. Robotic-assisted thoracoscopic (RATS) diaphragm plication combines the advantages of standard open thoracotomy and conventional thoracoscopic technique, gaining popularity as a less invasive alternative to improve the overall lung function. We present a case, to our knowledge, of the first described instance of abdominal compartment syndrome in the literature following RATS diaphragmatic plication. Abdominal compartment syndrome potentially developed as a consequence of downward hepatic shift and reduced intra-abdominal volume. This was inferred by changes in the patient's liver enzymes and was manifested by his oliguria and raised intra-abdominal pressure. The usual treatment of abdominal compartment syndrome is debatable as it usually involves conservative decompression including percutaneous options, but definitive surgical management includes decompression of the abdomen, often by emergent laparotomy, in those with moderately elevated intra-abdominal pressure. Conservative treatment by means of supportive therapy and abdominal decompression with nasogastric tube and passing of a flatus tube was performed in our case.