Case report

Anastomotic leak management after a low anterior resection leading to recurrent abdominal compartment syndrome: a case report and review of the literature

Kostas Toutouzas¹ , Eleftheria S Kleidi¹ , Panagiotis G Drimousis¹ , Margarita Balla² , Metaxia N Papanikolaou² , Andreas Larentzakis¹ , Dimitrios Theodorou¹ and Stylianos Katsaragakis¹

¹  1st Department of Propaedeutic Surgery, Surgical Intensive Care Unit, University of Athens, Athens Medical School, Hippocration Hospital, Athens, Greece

²  Intensive Care Unit, Hippocration Hospital, Athens, Greece

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Journal of Medical Case Reports 2009, 3:125doi:10.1186/1752-1947-3-125

Published:	14 November 2009

Abstract

Introduction

Low anterior resection is usually the procedure of choice for rectal cancer, but a series of complications often accompany this procedure. This case report describes successful management of an intricate anastomotic leak after a low anterior resection.

Case presentation

A 66-year-old Caucasian man was admitted to our hospital and diagnosed with a low rectal adenocarcinoma. He underwent a low anterior resection but subsequently developed fecal peritonitis due to an anastomotic leak. He was operated on again but developed abdominal compartment syndrome, multi-organ failure and sepsis. He was aggressively treated in the intensive care unit and in the operating room. Overall, the patient underwent four laparotomies and stayed in the intensive care unit for 75 days. He was discharged after 3 months of hospitalization.

Conclusion

Abdominal compartment syndrome may present as a devastating complication of damage control laparotomy. Prompt recognition and goal-directed management are the cornerstones of treatment.