Dear Dr. Roach • Two months ago, my husband fell down a flight of stairs and fractured six ribs and a vertebra in his neck. He is 65 years old and was in good health before this accident. He was hospitalized in a level 1 trauma center and was doing well until 10 days after the accident, when his abdomen became very swollen. He was rushed to the emergency room and was diagnosed with abdominal compartment syndrome; he needed emergency surgery to address the swelling of his major organs. He had an ileostomy and later needed another three major surgeries, including one for a collapsed lung. Breathing issues have been a major problem; he had a breathing tube inserted for three weeks. His voice has changed.
No more surgery is planned, and he is now in rehab. What causes the abdominal compartment syndrome that did so much damage, and how could it have been prevented? — B.E.
Answer • A “compartment syndrome” is when the pressure inside a closed system becomes high enough to affect the contents of the compartment. A compartment is a section of the body walled off by anatomic structures.
I am most familiar with compartment syndromes of an extremity. For example, there are different compartments of the arm and leg. Severe damage to a muscle can cause it to swell, increasing the pressure in the compartment so much that not enough blood can get to the injured muscle. It is a surgical emergency, requiring the opening of the compartment.
The abdomen itself is a compartment, with the anatomic structure being the lining of the abdomen. There are many possible causes for abdominal compartment syndrome. Trauma, such as what your husband suffered falling down the stairs, is among the most common. Surgery, sepsis, severe liver disease and burns also may cause ACS. ACS can cause compression of the lung, as you…