Percutaneous alleviation of abdominal compartment syndrome due to hemoperitoneum with simultaneous endovascular bleeding control: a case series

• Published in: Journal of vascular and interventional radiology Vol. 24; no. 4; pp. S136 - S137
• Main Authors: Friedman, T, Michalski, M.H, Detroy, E, Latich, I, Ayyagari, R, Arici, M.H, Mojibian, H.R
• Format: Journal Article
• Language: English
• Published: 01-04-2013
• Subjects: Radiology
• ISSN: 1051-0443
• DOI: 10.1016/j.jvir.2013.01.339

Learning Objectives Surgical decompressive laparotomy is the standard treatment for abdominal compartment syndrome (ACS). We demonstrate the feasibility of simultaneous bleeding control and alleviation of ACS, a method that can obviate the need for major surgical interventions plagued by preventable mortality and morbidity. Background ACS is defined by intrabdominal pressure greater than 20mm Hg with evidence of organ failure or dysfunction. Sequelae of ACS include decreased cardiac output due to IVC compression, decreased pulmonary compliance, renal dysfunction and intestinal and hepatic ischemia. Expeditious decompression of the abdomen is essential to allow reperfusion to vital organs. Decompressive laparotomies have been the mainstay of treatment but carry a mortality of 49%. We present a series of 3 cases of ACS due to massive hemoperitoneum caused by left inferior epigastric artery hemorrhage secondary to paracentesis, hepatic artery bleed after transjugular liver biopsy and hepatic artery injury during cardiac valve repair. All patients presented with clinical evidence of ACS, documented with bladder and direct abdominal pressure measurements. Clinical Findings/Procedure Details In each case, the bleeding artery was identified by selective angiography and embolized with particles - complete arterial occlusion was achieved. Ultrasound was then used to find the largest pocket of blood. After establishing access to the peritoneal space, direct intraperitoneal pressure was measured using an end hole catheter. The same access was then used to place a large bore drainage catheter in each case. Compartment syndrome resolved in each case as evidenced by intrabdominal pressures and patient’s clinical status. There were no acute or latent complications as a result of embolization or catheter drainage. Surgery was avoided in all three patients. Conclusion and/or Teaching Points Simultaneous embolization and percutaneous drainage is a feasible and significantly less morbid alternative to surgery in the management of ACS caused by hemoperitoneum.