Alper KARALOK, Osman TURKMEN, Eylem UNLUBİLGİN, Gunsu KİMYON, Zeynep UCAR, Selcan SINACI, Tolga TASCİ, Nurettin BORAN, Gokhan TULUNAY

Raising Awareness of Abdominal Compartment Syndrome after Gynecologic-Oncology Surgery

Elli altı yaşında, vücut kitle indeksi 44 kg/m2 olan sol adneksiyel alanda yaklaşık 6 cm solid kitleye sahip postmenopozal hastaya vertikal insizyon ile yapılan laparotomide intraoperatif patoloji sonucunun malign over tümörü olarak rapor edilmesi üzerine hastaya evrelendirici cerrahi uygulandı. Postoperatif 2. Günde, hastada dispne, soğuk terleme, taşikardi, taşipne gelişmiş ve barsak sesleri hipoaktif olarak saptandı. Takipte SO2 %88'di ve akciğer direk grafide sağ kostafrenik alan künttü. Arteriyel kan gazı sonucunda ph: 7.41, PCO2: 29.2 mmHg, SO2: % 86, HCO3: 18.2 mmol/L, ve baz açığı: -4.9 mmol/L idi. Spiral tomografi ile pulmoner emboli tanısı dışlandı. Hastanın mevcut bulgularına kusma ve abdominal distansiyon eklendi. Başlangıç intravezikal basıncın (İVB) manuel olarak 16 mmHg (22 cmH2O) saptanması üzerine hasta endolüminal dekompresyon metodları ve medikal yönetim ile takip edildi. Klinik bulgularda ve fizik muayenede gerileme olmaması üzerine 2 saat sonra ölçülen İVB 21 mmHg (28 cmH2O) idi. Hastaya abdominal kompartman sendromu tanısıyla dekompresif laparatomi uygulandı ve fasya açık bırakılıp sadece cilt onarımı ile operasyon tamamlandı. Hasta postoperatif 8. ayda hastalıksız olarak yaşamına devam etmekteydi. AKS açısından yüksek riske sahip yoğun bakım hastalarında aralıklı indirekt İVB ölçümü ile intraabdominal basınç monitorizasyonu AKS farkındalığını arttırma ve erken tanı açısından büyük öneme sahiptir. AKS'de erken dekompresif cerrahi hayat kurtarıcı basamaktır.

Jinekolojik-Onkoloji Cerrahisi Sonrası Abdominal Kompartman Sendromu Farkındalığını Artırma

A 56 years old female, body mass index 44 kg/m2, postmenopausal patient who had a solid mass of approximately 6-cm in diameter at the left adnexal area underwent laparotomy with vertical incision. Staging surgery was performed because of the frozen section result that was reported as a malignant ovarian cancer. On the postoperative 2nd day, the patient had dyspnea, cold sweats, tachycardia, tachypnea and bowel sounds were detected as hypoactive. SO2 was measured as 88% during follow-up and right costophrenic angle was appearing blunt in her chest X-ray. Arterial blood gas analysis results were as follows; ph: 7.41, PCO2: 29.2 mmHg, SO2: 86%, HCO3: 18.2 mmol/L, and base excess (BE): -4.9 mmol/L. There was no additional feature in the blood cell counts and biochemical tests. The diagnosis of pulmonary emboli was ruled out with thoracic spiral tomography. In the sequel, the patient began vomiting, while her bowel sounds were remained hypoactive with addition of abdominal distension. After the initial intravesical pressure (IVP) was measured as 16 mmHg (22 cmH2O) manually, the patient was observed with endoluminal decompression methods and medical management. The clinical signs and physical examination findings did not improve; IVP measured two hours later was 21 mmHg (28 cmH2O). Because of these clinical findings and the rise of sequential IVP measurements, the patient was diagnosed with abdominal compartment syndrome. Decompressive laparotomy was performed and completed by closing the skin without suturing the fascia. Eight months later, her overall condition was good and follow-up has continued. Monitoring intraabdominal pressure with intermittent indirect IVP measurements in intensive care patients with high risk for ACS has great significance for early diagnosis, increasing the awareness for this condition. Early decompressive surgery in ACS is the life-saving step.

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