Dramatic vascular compression by tension pneumoperitoneum

Excerpt

A 40-year-old man with a history of Crohn’s disease had undergone screening colonoscopy. After the procedure, the patient’s status rapidly deteriorated, associated with abdominal pain and a massively distended, tympanic abdomen with evidence of guarding. The abdominal CT scan showed a huge tension pneumoperitoneum with major vascular compression of the inferior vena cava, the portal vein, the abdominal aorta, and mesenteric vessels, as well as total interruption of iliac arterial blood flow (Fig. 1, arrows). An emergency decompressive laparotomy was performed and a sigmoid perforation was repaired. In the immediate postoperative period, he was admitted to ICU with severe multiple organ failure, including shock, acute respiratory distress syndrome, kidney failure with anuria, liver failure, and coagulopathy. A CT scan performed 5 days later showed extensive hepatic necrosis (Fig. 2, asterisk) secondary to blood flow interruption. The patient survived and was discharged from hospital at day 60.

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