Secondary Abdominal Compartment Syndrome Causing Failure to Wean From Cardiopulmonary Bypass

Phlegmasia Cerulea Dolens after Coronary Artery Bypass Surgery: What Should We Know

“…In addition, hypotension during CPB can worsen the tissue perfusion in the extremity, which may induce an inflammatory injury after reperfusion [4]. The systemic inflammatory aspects of its pathogenesis can lead not only to the lower limb compartment syndrome after conventional CABG but also to the abdominal compartment syndrome [6]. Local factors related to surgery are also believed to be important.…”

Secondary abdominal compartment syndrome required decompression laparotomy during minimally invasive mitral valve repair

“…Therefore, ACS could be fatal in a patient under cardiopulmonary bypass, as increased intraabdominal pressure can cause a failure of venous return. However, only a few cases of ACS during cardiopulmonary bypass have been reported [ 4 , 5 ], and there are no patients undergoing minimally invasive cardiac surgery.…”

“…Various nonsurgical approaches, such as intraabdominal fluid drainage and neuromuscular blockade, have been shown to reduce intraabdominal pressure [ 8 ]. A decompression laparotomy should be considered to relieve pressure and restore capillary perfusion in the organs of critically ill patients [ 4 , 5 ]. In the present case, a relatively long period of time was needed to make a diagnosis of ACS, as there were several points to check to determine the reason for instability of cardiopulmonary bypass due to the small incision and insufficient view of the heart, vessels, and other side of the pleural cavity, which might have caused massive fluid resuscitation and requirement of extracorporeal membrane oxygen.…”

eComment. Intra-abdominal hypertension and abdominal compartment syndrome in cardiac surgery patients

“…Decompressive laparotomy should not be feared or delayed because rapid decompression after the diagnosis of ACS dramatically improves cardiac function and results in improved organ perfusion and survival. Due to the severe morbidity associated with all forms of surgical decompression, the indications, timing and technique used should be carefully evaluated [3][4][5].…”

“…Both patients had a protracted clinical course, but they survived and were discharged from the hospital. Rabbi et al [5] described a secondary ACS that occurred during an elective coronary revascularization which resulted in an inability to wean from cardiopulmonary bypass. After decompressive laparotomy was done, the patient was successfully weaned from bypass.…”