Abdominal compartment syndrome due to subcutaneous emphysema.

1 of 2 DESCRIPTION A man in his late thirties presented with a 6 month history of fevers, dyspnoea, productive cough and an unintentional 50 pound weight loss. Evaluation revealed cavitating Hodgkin’s lymphoma. During the hospital course, a percutaneous drain was placed into a large cavity of the left upper lobe. When the drain was later removed while the patient was undergoing mechanical ventilation, massive subcutaneous emphysema developed rapidly ( fi gures 1 and 2A ) due to a fi stula at the drain site ( fi gure 2A , red arrow). Bladder pressures rose to 26 mm Hg with concomitant decline in urine output. Abdominal compartment syndrome (defi ned as organ dysfunction attributable to elevated intraabdominal pressures) was diagnosed. Four incisions were made to function as pressure release ‘blowholes’ with resulting rapid reduction in bladder pressures and improved urinary outfl ow ( fi gure 2B ).