Prevention of Abdominal Compartment Syndrome

A 20-year old male presented to the trauma service unresponsive and hypotensive following a motor vehicle collision. Warm crystalloid infusion brought his systolic blood pressure up to 130, but he remained tachycardic and appeared pale. Following a positive FAST exam, a laparotomy was performed which revealed over 2 liters of blood in the abdominal cavity, a shattered spleen, and a grade 3 liver laceration. A splenectomy was performed and all four quadrants packed. The abdomen was temporarily closed with an IV bag cover.

On day two he was taken back to the operating room for re-exploration. The packs were removed. He was hemostatic except for bleeding in the upper dome of the liver, which was controlled with further packing. There was no evidence of small bowel injury. After copious amounts of irrigation, a Wittmann Patch was sewn to the fascia to manage the swelling, prevent fascial retraction, and facilitate daily bedside re-entries. Over the next five days the abdomen was irrigated, re-explored, and the fascia gradually re-approximated. On day six he was returned to the operating room, the remaining patch material was removed, and the abdominal wall closed.

Damage control laparotomy.

Wittmann Patch with controlled tension on fascial edges to prevent retraction.

Re-entry and gradual re-approximation of fascia.

Fascia-to-fascia abdominal wall closure on day six.

Case report courtesy of

Dale Dangleben, MD; David Grossman, MD; Stanley Kurek, D.O.

Department of Trauma and Critical Care

Lehigh Valley Hospital

Allentown, PA 18105