A 20-year-old man presents in severe hemorrhagic shock due to multiple blunt trauma following a motor vehicle crash. He is taken to the operating room for emergency surgery, where he is found to have a completely shattered spleen and a 3-cm liver laceration. He undergoes a splenectomy and damage control laparotomy, and the abdominal wound is closed only at the skin with a running suture. He is transferred to the surgical ICU for ongoing resuscitation, but over the next 8 hours is noted to have decreasing urine output, worsening hypotension that is becoming refractory to fluid boluses, and poor oxygenation. Physical exam reveals poor peripheral perfusion, moderate abdominal distension, but no signs of acute wound infection.

severe hemorrhagic shock | multiple blunt trauma | shattered spleen | 3-cm liver laceration | splenectomy | decreasing urine output | worsening hypotension | poor oxygenation | poor peripheral perfusion | abdominal distension

Abdominal compartment syndrome

https://online.epocrates.com/diseases/112522/Abdominal-compartment-syndrome/Common-Vignette Epidemiology Historically, the prevalence of ACS was most frequently studied in the context of trauma, where it has been shown to occur in 1% of all general trauma admissions and 5% to 15% of trauma ICU admissions. [2] However, improvement in resuscitation and operative strategies in trauma patients has significantly reduced the prevalence of ACS. [3] Currently, in patients with known risk factors, intra-abdominal hypertension can be found in approximately 25% of ICU admissions with almost 3% having ACS. [4] Mortality rate is high, ranging from 25% to 75%, due to the presence of multi-organ failure and severe underlying injuries. [2] The mortality associated with elevated intra-abdominal pressure itself is attributable to ACS. [2]