Abdominal Compartment Syndrome Following Massive Transfusion in Upper Gastrointestinal Bleeding: A Case Report

Abdominal compartment syndrome (ACS) is defined as sustained intra-abdominal pressure (IAP) exceeding 20 mmHg, leading to organ hypoperfusion and dysfunction. Although most cases arise from intra-abdominal or retroperitoneal hemorrhage, ACS may also occur after massive transfusion due to capillary leak and fluid overload. We describe an 82-year-old man presenting with upper gastrointestinal bleeding from a duodenal ulcer who required massive transfusion. During resuscitation, he developed progressive ventilatory failure with rising airway pressures and refractory hypoxemia. Intra-vesical IAP measured 85 mmHg, confirming severe ACS. Emergency decompressive laparotomy evacuated over two liters of serous fluid and revealed a markedly distended bowel filled with intraluminal blood but no hemoperitoneum. Ventilatory parameters improved immediately after decompression. Despite timely surgical intervention and intensive supportive care, the patient developed renal failure, acute respiratory distress syndrome (ARDS), methicillin-resistant Staphylococcus aureus pneumonia, and progressive neurological decline, ultimately leading to transition to comfort measures. Although such presentations are uncommonly reported, this case highlighted the critical importance of maintaining high clinical vigilance in patients undergoing massive transfusion, particularly when acute respiratory deterioration occurs.