Annals of African Medicine
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CASE REPORT
Year : 2011  |  Volume : 10  |  Issue : 3  |  Page : 252-255

Abdominal Compartment Syndrome complicating massive hemorrhage from an unusual presentation of ruptured ectopic pregnancy


1 Department of Surgery, Hail General Hospital, Hail 81451, Saudi Arabia
2 Department of Obstetrics/Gynecology, Hail General Hospital, Hail 81451, Saudi Arabia
3 Department of Anaesthesiology, Hail General Hospital, Hail 81451, Saudi Arabia

Correspondence Address:
Robert B Sanda
Department of Surgery, Drumheller Hospital, Drumheller, AB, T0J 0Y1, Canada

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1596-3519.84700

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Abdominal Compartment Syndrome (ACS) is characterized by intra-abdominal hypertension (IAH), elevation and splinting of the diaphragm, high pleural pressure, and poor venous return to the heart, producing low cardiac output and shock which, in turn, results in poor venous return across the capillaries to set in a vicious cycle. Unless the Intra-abdominal pressure is reduced quickly by urgent surgical or medical interventions, death is inevitable. We report a case of ACS resulting from an unrecognized slow but massive intra-abdominal bleeding caused by a ruptured ectopic pregnancy (REP) in an Arab woman. Due to the unusual nature of the presentation of the REP, the diagnosis proved elusive for over a week until the patient succumbed to hypovolemic shock after losing about 4.2 l inside the peritoneal space. The fruitless effort at aggressive fluid resuscitation was at operation found not due to hypovolemia per se but due to IAH causing ACS. The lessons learned from this case emphasize the need for awareness about atypical presentations of REP and the need for quick intervention to terminate the vicious cycle of ACS.


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