Korean J Crit Care Med.  2016 Feb;31(1):58-62. 10.4266/kjccm.2016.31.1.58.

Secondary Abdominal Compartment Syndrome Recognized in Operating Room in Severely Injured Patients

  • 1Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea. galgunbam2@daum.net


For trauma patients with severe shock, massive fluid resuscitation is necessary. However, shock and a large amount of fluid can cause bowel and retroperitoneal edema, which sometimes leads to abdominal compartment syndrome in patients without abdomino-pelvic injury. If other emergent operations except intraabdomen are needed, a distended abdomen is likely to be recognized late, leading to multiple organ dysfunction. Herein, we report two cases of a 23-year-old woman who was in a car accident and a 53-year old man who was pressed on his leg by a pressing machine; severe brain swelling and popliteal vessel injury were diagnosed, respectively. They were both in severe shock and massive fluid resuscitation was required in the emergency department. Distended abdomen was recognized in both the female and male patients immediately after neurosurgical operation and immediately before orthopaedic operation in the operating room, respectively. Decompressive laparotomy revealed massive ascites with retroperitoneal edema.


abdominal compartment syndrome; shock; trauma

MeSH Terms

Brain Edema
Emergency Service, Hospital
Intra-Abdominal Hypertension*
Operating Rooms*
Young Adult


  • Fig. 1. Brain computed tomography scan shows severe brain edema (A) and bowel edema without no hemorrhage in abdominal cavity was observed (B).

  • Fig. 2. A time table until recognizing abdominal compartment syndrome in operating room. ED: emergency department, OR: operating room, CPR: cardiopulmonary resuscitation.

  • Fig. 3. Severe shock was caused by popliteal vessel injury (A) and laparotomy shows lots of ascites (B).

  • Fig. 4. A time table until recognizing abdominal compartment syndrome in operating room. ED: emergency department.



1. Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. I. Definitions. Intensive Care Med. 2006; 32:1722–32.
2. Balogh ZJ, van Wessem K, Yoshino O, Moore FA. Postinjury abdominal compartment syndrome: are we winning the battle? World J Surg. 2009; 33:1134–41.
3. Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013; 39:1190–206.
4. Burrows R, Edington J, Robbs JV. A wolf in wolf’s clothing--the abdominal compartment syndrome. S Afr Med J. 1995; 85:46–8.
5. Maxwell RA, Fabian TC, Croce MA, Davis KA. Secondary abdominal compartment syndrome: an underappreciated manifestation of severe hemorrhagic shock. J Trauma. 1999; 47:995–9.
6. Balogh Z, McKinley BA, Cocanour CS, Kozar RA, Holcomb JB, Ware DN, et al. Secondary abdominal compartment syndrome is an elusive early complication of traumatic shock resuscitation. Am J Surg. 2002; 184:538–43. discussion 543-4.
7. Carr JA. Abdominal compartment syndrome: a decade of progress. J Am Coll Surg. 2013; 216:135–46.
8. Balogh Z, Moore FA, Moore EE, Biffl WL. Secondary abdominal compartment syndrome: a potential threat for all trauma clinicians. Injury. 2007; 38:272–9.
9. Stein DM, Scalea TM. Capillary leak syndrome in trauma: what is it and what are the consequences? Adv Surg. 2012; 46:237–53.
10. Clarkson B, Thompson D, Horwith M, Luckey EH. Cyclical edema and shock due to increased capillary permeability. Am J Med. 1960; 29:193–216.
11. Bochicchio G, Ilahi O, Bochicchio K, Reese S, Scalea T. Traumatic induced capillary leak syndrome is highly predictive of mortality. 2011. April. [2015 Dec 4]. Available from: http://www.americansurgical.org/files/2011/ASA11-Program-Book-for-Web.pdf.
12. Duchesne JC, Heaney J, Guidry C, McSwain N Jr, Meade P, Cohen M, et al. Diluting the benefits of hemostatic resuscitation: a multi-institutional analysis. J Trauma Acute Care Surg. 2013; 75:76–82.
13. Duchesne JC, Barbeau JM, Islam TM, Wahl G, Greiffenstein P, McSwain NE Jr. Damage control resuscitation: from emergency department to the operating room. Am Surg. 2011; 77:201–6.
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