Aortic Occlusion Syndrome Secondary to Abdominal Compartment Syndrome, a Case Series of 2 Cases
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CASE REPORT
Aortic Occlusion Syndrome Secondary to Abdominal Compartment Syndrome, a Case Series of 2 Cases Irshad Ahmad 1 & Mohd Ilyas 2 & Ajaz A. Rather 1 Received: 19 April 2019 / Accepted: 8 April 2020 # Association of Surgeons of India 2020
Abstract The present article discusses the case series of computed tomography (CT) images of two cases of abdominal compartment syndrome which resulted in the abdominal aortic occlusion and subsequent vascular compromise of the abdominal viscera. The report is first of its kind to show that even aorta can be occluded by the bowel obstruction. Keywords Abdominal compartment syndrome . Intestinal obstruction . Aortic occlusion syndrome . Computed tomography
Introduction Abdominal compartment syndrome is more common in intensive care patients affecting all body systems [1]. The rarity in the present cases is that no previous significant associated history was there. It is a potentially fatal condition resulting from increased intra-abdominal pressure. The imaging signs include direct organ compression or displacement, bowel wall thickening, and non-perfusion of the organs due to occlusion of the blood supply due to increased intra-abdominal pressure. The development of pressures likely to occlude aorta is extremely rare as it requires more than 120 mmHg pressure to occlude the aorta [2].
Case Reports Case 1 A 38-year-old male presented to the surgical emergency section with the chief complaints of acute abdominal pain and abdominal distension for past 4–5 h. There was no previous history of any similar complaint and no history of any * Irshad Ahmad [email protected] 1
Department of General Surgery, SKIMS Medical College Bemina, Srinagar, Jammu and Kashmir, India
2
Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
previous surgical intervention. The physical examination revealed tense, distended and guarded abdomen. The blood pressure in left upper arm was 200/120 mmHg with absent femoral pulse. The radial pulse was 106/min, and respiratory rate of 22/min. The arterial blood gases showed pH of 7.19, HCO3 12.7 mmol/L, PaCO2 26.07 mmHg, PaO2 96 mmHg, Na+ 136 mmol/L, K+ 3.2 mmol/L, chloride 105 mmol/L and lactate of 8.7 mmol/L. Ultrasonography of the abdomen could not reveal any significant pathology due to excessive artifact because of the abdominal gas. Contrast-enhanced computed tomography of the abdomen was performed immediately. The study revealed hugely dilated stomach with air and food material and grossly dilated colon causing compression of the abdominal viscera including the kidneys, liver, spleen and pancreas. There was complete occlusion of the descending abdominal aorta at D-10 vertebral level (Fig. 1a–c). None of the abdominal viscera showed adequate contrast enhancement suggesting the occlusion of the blood supply to all organs. The perfusion of the heart, thoracic aorta and lungs was normal. All these features were consistent with abdominal compartment syndrome resulting in complete occlusion o
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