BackgroundIntra-abdominal pressure (IAP) can be measured by several indirect methods; however, the urinary bladder is largely preferred. The aim of this study was to compare intra-bladder pressure (IBP) at different levels of IAPs and assess its reliability as an indirect method for IAP measurement.MethodsWe compared IBP with IAP in twenty-one patients undergoing laparoscopic cholecystectomy under general anesthesia. Measurements were recorded at increasing levels of insufflation pressures to approximately 22 mmHg. Pearson’s correlation coefficient was calculated to establish the relationship between the two pressure measurements and Bland-Altman analysis was used to assess the limits of agreement between the two methods of measurements.ResultsThe urinary bladder pressures reflected well the pressures in the abdominal cavity. Pearson correlation coefficient showed a good correlation between the two measurement techniques (r = 0.966, p < 0.0001) and Bland-Altman analysis indicated that the 95% limits of agreement between the two methods ranged from − 2.83 to 2.64. This range is accepted both clinically and according to the recommendations of the World Society of Abdominal Compartment Syndrome (WSACS).ConclusionOur study showed that IBP measurement is a simple, minimally invasive method that may reliably estimates IAP in patients placed in supine position. Measurements for pressures higher than 12 mmHg may be less reliable. When applied clinically, this should alert the clinician to take safety measures to avoid abdominal compartment syndrome (ACS).

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Objective: Abdominal scar endometriosis is a recognized condition that has been described following a wide variety of gynaecological procedures. We report a case of endometrioma, presenting as a painful subumbilical swelling, mimicking an incarcerated incisional hernia. Clinical Presentation: A 35-year-old woman presented with a painful subumbilical swelling that had been present for 6 months, but had increased in size and become more painful the day prior to admission. Her past medical history included four caesarean sections. Physical examination revealed a firm, tender and irreducible subumbilical nodule with no cough impulses, mimicking a small incarcerated incisional hernia. Intervention: Exploratory laparotomy through the same lower midline incision revealed a subcutaneous swelling resembling an organized chocolate cyst of endometriosis. Apart from intra-abdominal adhesions, no connection to intra-abdominal structures was identified. Histopathology of the specimen was consistent with abdominal scar endometriosis. Conclusion: Endometrioma was diagnosed in this 35-year-old woman following histological examination of a specimen removed during laparotomy. It is recommended that endometrioma should be considered in the differential diagnosis of subcutaneous, scar-related hernias and various abdominal wall masses following gynaecological operations.

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