A53-05 Rapidly Bleeding Subcarinal Mass Causing Acute Abdominal Compartment Syndrome

Introduction Compartment syndrome is characterized by compromised tissue perfusion due to elevated pressure within a confined anatomical space, can manifest in various locations throughout the body, result from diminished abdominal wall compliance, increased abdominal volume, or capillary leak/fluid resuscitation. Baseline intra-abdominal pressure (IAP) of 5 to 7 mm Hg is commonly observed in critically ill patients. Intra-abdominal hypertension (IAH) is defined as a sustained or repeated IAP ≥ 12 mm Hg. Progression to abdominal compartment syndrome (ACS) occurs when IAP exceeds 20 mm Hg. This case report highlights case of actively bleeding mediastinal mass presenting initially with cough rapidly leading to increased extraluminal abdominal volume leading to significant compromise of microcirculatory perfusion, cellular ischemia, multi-organ dysfunction and eventual death within 2 hours. Case Description A 59-year-old man with a history of pulmonary embolism on Coumadin presented with upper abdominal pain, cough, cramping, and nausea. Initially stable, labs showed leukocytosis (19K) and elevated INR (3.4). CTA chest revealed an actively bleeding 7 × 6 cm subcarinal mass encasing the lower trachea and central bronchi. He developed refractory hypotension requiring pressors, transfusions, and intubation. Rapid abdominal distension and worsening oxygenation ensued; repeat X-ray showed elevated right hemidiaphragm and increasing pleural effusion. Chest tube drained frank blood. Bladder pressure was 34 mm Hg. Due to instability, surgery was not feasible. The patient suffered cardiopulmonary arrest and died despite resuscitative efforts. Discussion Abdomen compartment syndrome may initially present with subtle clinical findings but can lead to rapid increase in abdominal pressure within minutes resulting in multiorgan collapse and eventual death. ACS leads to elevated intrathoracic pressures limiting pulmonary compliance leading to elevated pulmonary pressures. Early recognition and possible surgical decompression may lead to better clinical outcomes. This case highlights importance of early recognition and treatment of ACS and challenges of managing patients who often require respiratory and multiorgan organ support. Conclusion ACS is life-threatening condition that may results from rapidly bleeding intrathoracic mass. If left untreated this may result in sudden cardio-pulmonary collapse. This case report emphasizes importance of considering ACS in differential diagnosis in patients with minimal abdominal symptoms as this may aid to early surgical decompression leading to better clinical outcomes. This abstract is funded by: None