Percutaneous catheter drainage in the treatment of abdominal compartment syndrome.

A 20-year-old man presented after falling over the edge of a tractor. On examination, he was conscious and oriented. The pulse was feeble and blood pressure was not recordable. The abdomen was distended, and there was tenderness in the right upper quadrant. Bowel sounds were sluggish. Bedside ultrasonography detected a hemoperitoneum and a liver laceration. Chest radiography showed elevated diaphragmatic domes. Contrast-enhanced computed tomography (CT) showed a shattered right lobe and segment 4 of the liver; segments 2 and 3 were spared. The portal venous and hepatic arterial branches were seen opening into the peritoneal cavity not covered by liver parenchyma, suggesting a grade V liver injury (Fig. 1). There were associated multiple rib fractures, pelvic fracture, moderate hemoperitoneum (Fig. 2), minimal right hemothorax and an attenuated inferior vena cava. He was resuscitated and managed conservatively. Four days after admission, his abdomen gradually became distended, and this was associated with tachypnea and tachycardia. Ultrasonography revealed an increased collection of intraperitoneal fluid. Intra-abdominal pressure measured indirectly with a transurethral bladder catheter was 26 mm Hg. Based on the clinical features, findings on ultrasonography and intraabdominal pressure measurement, we diagnosed ACS. Under ultrasonographic guidance, we inserted an 18-gauge puncture needle into the right paracolic gutter. After serial dilatations over an Amplatz Super Stiff Wire (Boston Scientific), a 16-French pigtail catheter was inserted into the right paracolic gutter. Another 16-French pigtail drainage tube was placed into the left paracolic gutter. About 3 L of altered blood was collected in the next hour. Intra-abdominal pressure dropped to 8 mm Hg. The patient recovered within 2 weeks with conservative management.