Case history
Case history #1
A 20-year-old man presents in severe haemorrhagic shock due to multiple blunt trauma following a motor vehicle crash. He is taken to the operating room for emergency surgery, where he is found to have a completely shattered spleen and a 3-cm liver laceration. He undergoes a splenectomy and damage-control laparotomy, and the abdominal wound is closed only at the skin with a running suture. He is transferred to the surgical ICU for ongoing resuscitation, but over the next 8 hours is noted to have decreasing urine output, worsening hypotension that is becoming refractory to fluid boluses, and poor oxygenation. Physical examination reveals poor peripheral perfusion, moderate abdominal distension, but no signs of acute wound infection.
Case history #2
A 70-year-old woman with known cirrhosis presents to the emergency department with severe hypotension and respiratory failure due to sepsis from a urinary tract infection. She undergoes aggressive fluid resuscitation that continues in the medical ICU. In the fourth hour of resuscitation she is noted to have oliguria, hypoglycaemia, and worsening metabolic and respiratory acidosis. Physical examination reveals a tense, distended abdomen with clinically apparent ascites. Her extremities are warm and well perfused.
Use of this content is subject to our disclaimer