Síndrome compartimental abdominal en el postoperatorio de un paciente con aneurisma de aorta abdominal infrarrenal fisurado. Caso clínico y revisión de la bibliografía

A 79-year-old male with the usual vascular risk factors, who visited the Emergency Department because of symptoms consisting in lower back pain and an abdominal pulsatile mass that was found in the examination. Following a computerised axial tomography scan, which confirmed the diagnosis and precluded the possibility of endovascular therapy, the patient was submitted to open surgery, which involved exclusion of the aneurysm and an aortobifemoral bypass. During the early phase of the post-operative period the patient showed progressive clinical deterioration, oligoanuria and severe abdominal distension. In consequence, after ruling out other causes of multiple organ failure and with the suspicion of possible ACS, the intravesical pressure was measured. After confirming the existence of high pressure within the abdomen, a second operation was performed to carry out a decompressive laparotomy. In the review of the literature, the pathophysiology, diagnostic methods and treatment of ACS are discussed. Conclusions. There is a group of patients in whom the identification of situations of higher risk of developing ACS is essential so that an early intervention can prevent a fatal outcome that leads to multiple organ failure and death.