A Case of Abdominal Compartment Syndrome Due to Mucinous Ovarian Tumor

Abstract

Abdominal compartment syndrome (ACS) is defined as intra-abdominal hypertension with sustained increased intra-abdominal pressure causing new organ dysfunction [1]. Most commonly associated with trauma, burns, or liver transplantation, but in select cases ACS can be associated with intra-abdominal masses [2,3]. Definitive treatment is surgical decompression [2]. CASE PRESENTATION: A 51 year-old female presented to the ED via EMS for weakness and hypoglycemia. The patient stated that her symptoms developed earlier that day. Only past medical history was type 2 diabetes. Physical exam revealed dry mucous membranes, decreased breath sounds bilaterally, and a markedly distended abdomen firm to palpation. Reportedly, the abdominal distention had been present and worsening for >1 year. Initial labs: Na+ 129 mEq/L, BUN 29 mg/dL, Cr 1.5 mg/dL, platelet count 628,000 cells/mL, glucose 38 mg/dL. CT abdomen/pelvis showed an ovarian/uterine mass measuring approximately 40 cm x 34 cm x 40 cm. CEA, CA 125 and CA19-9 were 17.4 ng/mL, 22 U/mL and 1396 U/mL, respectively. She was administered D50 and started on a D5 IV infusion. Overnight, she began to experience worsening respiratory distress requiring BiPap. She ultimately required intubation and was transferred to ICU. Bronchoscopy was performed at bedside but was unremarkable. Mechanical ventilation remained difficult due to abdominal pressure unless in the right lateral recumbent position. Ultrasound-guided paracentesis obtained 4 L of dark, viscous fluid over 1.5 hours. Post paracentesis, her oliguria and hypotension worsened. Unfortunately, she suffered a cardiac arrest and expired before she could be taken for mass removal