Abdominal compartment syndrome during intraoperative hyperthermic intraperitoneal chemotherapy following debulking surgery for colorectal cancer: a case report

Abstract

Background Colorectal cancer frequently leads to peritoneal metastasis and necessitates treatments, such as hyperthermic intraperitoneal chemotherapy (HIPEC). However, HIPEC may result in perioperative complications, some often overlooked, such as abdominal compartment syndrome. Case presentation A 52-year-old female with colorectal cancer and peritoneal metastasis underwent debulking surgery followed by HIPEC. Extensive tumour burden and a 9-hour surgery resulted in a blood loss of 3200 mL; 10 units of packed red blood cells were transfused. During HIPEC, a sudden increase in airway pressure and severe hypotension were noted. The abdomen was tensed, thus suggesting abdominal compartment syndrome, and prompting termination of HIPEC and drainage of the chemotherapeutic solution. Despite intravenous fluids and vasopressors, she experienced circulatory and respiratory collapse. Laparotomy sutures were promptly removed, which effectively alleviated the intra-abdominal hypertension and immediately restored the vital signs. An inadequately repaired diaphragm defect was identified and repaired. A chest tube was inserted for pneumothorax. Conclusions Abdominal compartment syndrome is a critical complication of HIPEC. It can mimic HIPEC’s physiological effects and result in adverse outcomes.