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

Hemostatic resuscitation: blood product replacement during cesarean delivery.

Prone position ventilation in severe acute pancreatitis patients with concurrent acute respiratory distress syndrome and abdominal compartment syndrome: a case report.

Growing evidence supports the addition of fresh frozen plasma (FFP) to a standardized crystalloid-based burn resuscitation. FFP is thought to mitigate endotheliopathy, decrease total fluids and improve outcomes; however, when and how much FFP to give remains controversial. Here, we assessed the safety and efficacy of adding a non-titratable, 8-hour FFP infusion of 0.5 mL/kg/% total body surface area (TBSA) to a burn resuscitation. We performed an unmatched retrospective cohort review on all burn patients aged >18 years old with >20% TBSA burns who underwent our nursing-driven resuscitation protocol that included this early, standardized FFP infusion, from November 2016-May 2020. Fifty-three patients received FFP and met inclusion criteria. Patients were primarily male (85%), with a median age 36 years and a TBSA burn of 39% (range 24.5-94%). Median time to FFP administration was 7 hours from injury with a median of 1517 ml infused. Median input/output (I/O) ratio improved from 0.8 at FFP initiation to 0.4 at 3 hours post FFP, p<0.001. Median urine output (UOP) improved from 0.19 ml/kg/hr prior to FFP administration to 0.52 ml/kg/hr at 3 hours post FFP, p<0.001. No complications related to resuscitation such as abdominal compartment syndrome, acute respiratory distress syndrome, or transfusion reactions occurred. Therefore, adding a low-dose, standardized FFP infusion to burn resuscitations significantly improved UOP, normalized I/O ratios and did not cause any known complications. Standardizing a safe, effective, non-titratable FFP infusion provides the framework to systematically test how colloids can be optimized during burn resuscitations in the future.

Ventral hernias remain one of the most prevalent and socially significant challenges in contemporary abdominal surgery. Patients with obesity present unique difficulties due to specific pathological anatomy, diminished tissue regenerative capacity, and an elevated risk of postoperative complications.Objective. To enhance the safety and efficacy of ventral hernia treatment in obese patients by optimizing the technical aspects of open non-tension hernia alloplasty.Materials and Methods. This prospective study included 121 patients with ventral hernias and concurrent obesity treated surgically at the Samarkand Branch of the Republican Center for Emergency Medical Care from 2016 to 2025. Patients were allocated into two groups: a control group (54 patients) underwent hernioplasty using the Devlin method with Zhebrovsky’s modification, while the primary group (67 patients) received a novel non-tension hernia alloplasty technique involving U-shaped suture fixation of the hernia defect edge and on-lay endoprosthesis placement. Preoperative preparation included cardiology and pulmonology consultations and pulmonary function tests Preoperative preparation included cardiology and pulmonology consultations and pulmonary function tests, including the Stange test, vital capacity, maximum voluntary ventilation, and other assessments. The novel technique involved meticulous tissue dissection and endoprosthesis fixation without aponeurotic tension to minimize organ injury and complications risk. All procedures were conducted in accordance with the World Medical Association's Declaration of Helsinki (2000 amendments).Results. Postoperative complications occurred in 6 (8.9%) patients in the primary group versus 8 (14.8%) in the control group, demonstrating a statistically significant reduction with the novel technique (p=0.045). Complications included wound-related issues and bronchopulmonary complications, with rare cardiovascular events and one case of abdominal compartment syndrome in the control group. Gastrointestinal function was preserved in 119 (98.4%) patients. Long-term follow-up (1–5 years) in 98 (76.8%) patients showed no recurrences in the primary group, unlike the control group. Mean hospital stay was 7 days in both groups, with reduced pain and faster return to work in the primary group.Conclusions. The novel non-tension hernia alloplasty technique, utilizing U-shaped sutures and on-lay endoprosthesis, proved highly effective in obese patients, significantly reducing postoperative complications and eliminating long-term hernia recurrence. This method minimizes surgical trauma, accelerates recovery, and improves clinical outcomes, offering a promising approach for managing ventral hernias in this high-risk population.

Surgical treatment of large postoperative ventral abdominal hernias (PVAH) using classical allogernioplasty techniques (sublay, onlay) is often accompanied by increased intra-abdominal pressure (IAP) and decreased abdominal volume, which can lead to abdominal compartment syndrome (ACS) in 2.4–3.6% of cases and mortality in 1.2–3.4% [1,2]. Therefore, closing a large abdominal wall defect requires a technique that does not elevate IAP. The use of anatomical component separation of the anterior abdominal wall by the modified Ramirez technique combined with sublay alloplasty helps restore optimal abdominal volume and improves outcomes, particularly by reducing ACS incidence [3–5]. However, combined surgery with a classical polypropylene mesh is associated with a high rate of postoperative wound complications—seroma (30.8–60.4%), wound suppuration (4.8–6.4%), ligature fistula (1.2–3.0%), and meshoma (0.06–1.60%) [6,7]. A key cause is aseptic inflammation of abdominal wall tissues due to contact with the polypropylene mesh. We believe that using a modified polypropylene mesh impregnated with polyhexamethylene guanidine chloride and carbon nanotubes will improve outcomes in thin and cachectic patients with large PVAH.Aim. To improve the results of surgical treatment of large postoperative abdominal hernias (PVAH) in thin and cachectic patients using a modified polypropylene mesh.Material and methods. The surgical treatment of 152 patients with large inguinal hernia was analyzed. Depending on the type of mesh implant used during surgical treatment, the patients were divided into two groups. In 76 (50%) patients in group I, hernia excision and hernioplasty were performed using a modified polypropylene mesh, in group II, 76 (50%) patients underwent surgery using a classic polypropylene mesh.Results and discussion. Statistically significantly better results were obtained in patients of group I compared to group II. The duration of inpatient treatment in group I was (7.0±1.0) days, in group II – (12.0±2.2) days.Conclusion. Surgical treatment of large PVAH in thin and cachectic patients using a modified polypropylene mesh is much more effective compared to the use of a classic polypropylene mesh, as evidenced by a decrease in the frequency of postoperative complications.

Suspected Abdominal Compartment Syndrome during Unilateral Biportal Endoscopic Spine Surgery

Abstract Purpose of Review Understanding the pathophysiology and risk factors for developing abdominal compartment syndrome is paramount to early diagnosis and management. Recent Findings Continuous pressure monitoring and drainage with percutaneous catheter decompression (PCD) can potentially avoid open surgery and improve survival in patients with intraabdominal hypertension (IAH). Future research will elucidate these findings. Summary Abdominal compartment syndrome (ACS) occurs when there is end organ dysfunction because of increased intra-abdominal pressure (IAP). Although this increase in pressure can be caused by an increase in extraluminal contents of the abdomen it is most frequently the result of systemic illnesses that necessitate massive fluid resuscitation. This leads to increased bowel edema and abdominal contents while also decreasing abdominal wall compliance. No matter what the etiology of ACS, it can lead to organ failure and death. Early recognition of ACS is necessary because early treatment is the best predictor of decreased morbidity and mortality. Clinical Trial Number Not applicable.

Abdominal compartment syndrome in the pediatric population - Case series and review of the literature.

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are now recognized as important but often underdiagnosed contributors to cardiovascular instability in critically ill patients. Recent studies have clarified the mechanisms by which elevated intra-abdominal pressure (IAP) reduces venous return, raises intrathoracic pressure, and impairs both preload and contractility while increasing afterload. These pathophysiological changes can compromise organ perfusion even at modest IAP elevations, and the interplay between cardiovascular, renal, and hepatic dysfunction has led to the concept of the cardio-abdomino-renal syndrome. Advances in monitoring have shifted practice away from static pressure indices such as central venous and pulmonary artery occlusion pressures. Emerging evidence supports the use of abdominal perfusion pressure, mean perfusion pressure, and volumetric indices obtained by transpulmonary thermodilution, alongside echocardiography and ultrasound-based venous congestion assessment. These tools enable individualized resuscitation strategies, balancing fluid therapy with the risks of exacerbating IAH. The purpose of this review is to synthesize recent evidence on the cardiovascular consequences of IAH and ACS, highlight evolving monitoring techniques, and outline current approaches to management. By integrating updated concepts into clinical practice, early recognition and targeted interventions may mitigate multi-organ dysfunction and improve patient outcomes.

Background Factors affecting outcomes in patients with abdominal compartment syndrome (ACS) associated with acute pancreatitis (AP) have not been well studied. Methods All patients admitted with a diagnosis of AP or ACS between 2016 and 2022 were selected by using the relevant International Classification of Disease (ICD)-10 codes from the National Inpatient Sample. Multivariate binary logistic regression was used to assess the odds of mortality in the setting of ACS secondary to AP. Results A total of 708 patients with AP and ACS were identified. Age and additional ICD-10 diagnoses, including sepsis, acute renal failure, malnutrition, intestinal obstruction, and ileus, were found to have statistically significant odds ratios. Older patients and those with sepsis and acute renal failure had greater odds of experiencing inpatient mortality. Conversely, those with malnutrition, ileus, and intestinal obstruction were found to have lower odds of inpatient mortality. Conclusions Our results suggest a higher mortality in patients with older age, sepsis, and acute renal failure in the setting of ACS. It also seems that readily treated factors such as malnutrition, intestinal obstruction, and ileus are associated with lower odds of mortality.

Abdominal compartment syndrome is a life-threatening condition caused by elevated intra-abdominal pressure, leading to impaired organ perfusion and dysfunction. In pediatric patients-especially neonates-diagnosis is challenging due to non-specific signs and limited clinical awareness. Pediatric abdominal compartment syndrome remains underrepresented in the literature, with few published cases and no standardized guidelines for diagnosis or management in this age group. We report the case of a premature newborn from a twin pregnancy who developed abdominal compartment syndrome following surgical repair of an omphalocele, emphasizing the value of ultrasound as an effective tool for the diagnosis and monitoring of abdominal compartment syndrome. This report contributes to the limited evidence available, highlighting the need for vigilance in similar high-risk scenarios, as early recognition and timely intervention are crucial to prevent irreversible damage.

HYPA study: protocol for investigating intra-abdominal hypertension and abdominal compartment syndrome in patients undergoing open and robotic pancreatic procedures

Giant omphalocoeles, defined by a defect larger than 5 cm or significant liver herniation, present unique challenges due to viscero-abdominal disproportion. Traditional staged closure techniques aim to gradually reduce herniated organs but carry risks such as abdominal compartment syndrome and prolonged recovery. The use of an innovative vertical traction approach improves the compliance of the abdominal cavity through stretching of muscles and fascia and enables tension-free closure. We present the case of a female neonate with giant omphalocoele treated with this device.

Disclosure: K. Sargon: None. V. Florova: None. R. Alshantti: None.Introduction: Myxedema coma, a rare andlife-threatening endocrine emergency, occurs at the extreme end ofhypothyroidism, and it can precipitate multisystem failure. Thegastrointestinal (GI) manifestations of hypothyroidism, such as colonicdistension and constipation, are often overlooked due to the precedence ofneurological/neuromuscular and cardiovascular symptoms. In severehypothyroidism, colonic pseudo-obstruction can occur via fecal impaction,resulting in megacolon or intestinal pseudo-obstruction; this may in turn leadto other systems and organs complications. We present a case illustrating thesevere physiological and anatomical GI consequences of untreated congenitalhypothyroidism over an extended period. Case Description: A 53-year-old female withcongenital hypothyroidism, non-adherent to levothyroxine therapy for over adecade, presented with progressive dyspnea and massive abdominal distension. Onadmission, vital signs included bradycardia (51 bpm), blood pressure (110/67mmHg), and oxygen saturation (91% on room air), with a BMI exceeding 50.Laboratory tests revealed severe hypothyroidism (TSH 185 µIU/mL, free T4<0.3 ng/dL). Imaging studies showed multifocal lung consolidation andsignificant colonic stool burden. The initial myxedema score was 50.The patient was started onintravenous glucocorticoids and levothyroxine, as well as antibiotics forpneumonia. However, her condition rapidly deteriorated, necessitatingintubation, vasopressor support, and colonic decompression. The clinical coursewas complicated by sigmoid perforation requiring surgical repair, and acutekidney injury, which in part was attributed to abdominal compartment syndrome,necessitating dialysis. Despite biochemical improvement in severehypothyroidism, multidisciplinary and ICU supportive care, patient’shemodynamic condition remained critical, with poor tolerance to hemodialysis.After a two-week hospitalization, the patient's family elected to transition tocomfort care, and she expired within 24 hours. Conclusion: Our case illustrates thecatastrophic GI consequences of untreated severe chronic hypothyroidism,leading to colonic dysmotility, fecal impaction, and megacolon. The resultingsevere bowel distention and abdominal compartment syndrome precipitatedhemodynamic, respiratory, and renal deteriorations, ultimately culminating in afatal outcome. This serves as a reminder of the challenges of reversingsystemic complications of severe hypothyroidism, even with advanced criticaland multidisciplinary care, and emphasizes the importance of thyroid hormonereplacement adherence in preventing such devastating outcomes in patients withcongenital hypothyroidism or no residual thyroid function.Presentation: Saturday, July 12, 2025

Effective pre-operative risk stratification and classification are crucial for optimizing surgical outcomes in giant inguinal hernias (GIHs). However, there is no universally accepted classification system for GIH, which complicates risk assessment, surgical planning, and research comparability. This narrative review aims to evaluate existing classification systems for GIH and identify their limitations. There is a proposal for a new classification system that might need to be tested widely. Several classification systems were identified. The classification of GIH was based on four broad groupings: Skin redundancy, risk of abdominal compartment syndromes, scrotal volumes, and lower-limb landmarks alone. Most of these classifications failed to incorporate key risk factors such as loss of domain, visceromegaly, and the potential for abdominal compartment syndrome. In addition, most existing classifications did not account for inguinoscrotal hernias above the mid-thigh. Most current classification systems for GIH have significant limitations, particularly in preoperative risk stratification and surgical planning. There is an urgent need for a standardized, comprehensive classification that considers key prognostic factors such as loss of domain and the risk of abdominal compartment syndrome. Future research is necessary to refine the existing classification models and develop a universally accepted system that improves patient outcomes and facilitates research comparison.

S5520 The Liver That Broke the Belly: Abdominal Compartment Syndrome From Isolated Hepatomegaly

Complications in hip Arthroscopy: Recognizing and managing adverse events.

Acute Pancreatitis with Abdominal Compartment Syndrome Is Strongly Associated with Increased Risk of Kidney Complications: A Multi-Institutional, Real-World Study

S3468 Severe Acute Pancreatitis With Abdominal Compartment Syndrome, Colonic Necrosis, and Splenic Artery Aneurysm Rupture: A Case of Multi-Organ Failure Requiring Multidisciplinary Management