Non-ICU-Based Staged Management of Laparotomy-Related Abdominal Compartment Syndrome in a 23-Year-Old Male

Abstract

Introduction: Abdominal compartment syndrome (ACS) is a sustained intraabdominal pressure (IAP) of 20 mmHg or higher with new organ dysfunction. Decompression is required when IAP exceeds 25 mmHg even without evidence of organ dysfunction. Common abdominal surgical diseases and operations can be complicated by ACS, and clinicians should have the requisite capacity to detect and intervene early enough. Intensive care unit (ICU) care has traditionally been the mainstay of ACS management. Case Presentation: A 23-year-old male was referred with a combined mesh and Bogota bag anterior abdominal construct after a midline laparotomy 24 hours earlier, following which the abdominal wall could not be closed primarily without tension. This was the result of significant edema of the bowel and retroperitoneum. This patient, after adequate resuscitation, underwent a two-staged procedure, 6 days apart, to achieve skin closure. After an unremarkable skin healing, a mesh repair for the consequent incisional hernia was carried out 15 months later. Conclusions: This patient’s ACS was successfully managed in a non-ICU setting and could demonstrate the possibility of successfully managing selected cases of laparotomy-related ACS in low-resource settings without ICU facilities.