Cardiac Arrest Secondary to Abdominal Compartment Syndrome: Diagnostic and Management Considerations for Emergency Physicians.

BACKGROUND: Abdominal compartment syndrome (ACS) is a rare but life-threatening complication of small bowel obstruction. Early recognition and intervention in the emergency department (ED) is imperative to preventing further complications and reducing mortality in these patients.

CASE REPORT: We present a case of a 42-year-old man with recent history of Nissen fundoplication, presenting to the ED with a small bowel obstruction, who was unable to be conservatively managed due to challenges placing the nasogastric (NG) tube. As the patient was being transitioned to the operating room, he progressed to ACS and cardiac arrest, requiring a bedside laparotomy in the ED for return of spontaneous circulation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: A high level of suspicion for ACS by emergency physicians can help this patient population reach definitive treatment sooner. Early detection including obtaining a bladder pressure to measure for intra-abdominal hypertension is significant. Primary interventions for ACS that can be done in the ED include conservative management with intraluminal decompressions via NG and rectal tube placement in addition to maintaining adequate blood pressure. If challenges arise with NG tube insertion, various techniques can be exercised to increase the odds of successful tube placement.