A Common Emergency with an Uncommon Twist

​BY ADAM JONES, MD, & LUKE METZKER, DOAbdominal compartment syndrome is a recognized emergency following abdominal trauma and surgery, but apparently it can also be spontaneous. A 58-year-old mentally delayed and autistic man presented to the ED with acute onset severe abdominal pain, a rigid abdomen, and respiratory failure. His lower extremities were mottled, and he was obviously in acute distress. He was intubated, and an orogastric tube was placed in preparation for exploratory surgery.Initial chest x-ray showing severe gastric distension.After the tube was placed, the patient's abdomen decompressed and color returned to his lower extremities. He went for exploratory laparotomy by general surgery, but no evidence of bowel perforation was found. He had an uneventful hospital course, and was discharged.​Approximately one month later, he returned with the same complaint. Again, it was noted approximately 20 minutes before arrival that he began to have abdominal distension, respiratory distress, and mottled lower extremities. His legs were a deep shade of purple, there was pitting edema present, and his capillary refill was less than 10 seconds. He was intubated for hypoxic respiratory failure, and again an OG tube was placed.His abdominal rigidity and distension immediately resolved, and a large volume of air came through the OG tube. Color returned to his extremities, and he went for a CT scan. No evidence of perforation or obstruction was found. He had metabolic ac...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research