J Med Case Reports. 2014;8(368)
Abstract and Introduction
Introduction Intra-abdominal hypertension and abdominal compartment syndrome have been increasingly recognized as a hip arthroscopy complication over the past decade. In the absence of consensus definitions and treatment guidelines, the diagnosis and management of intra-abdominal hypertension and abdominal compartment syndrome remains variable from institution to institution.
Case presentation We report the occurrence of the extravasation of fluid into the abdomen during arthroscopic treatment of femoroacetabular impingement combined with resection of trochanteric bursa and our management of the condition in a 55-year old Caucasian woman.
Conclusions We present an algorithm of treatment of abdominal compartment syndrome, as a hip arthroscopy complication, according to the consensus definitions and recommendations of the World Society of the Abdominal Compartment Syndrome. In the algorithm options, we have included paracentesis and percutaneous catheter decompression as the main point of treatment. Our algorithm will have a broader clinical impact on orthopedic surgery, anesthesiology and emergency medicine.
By having an upgraded understanding of hip anatomy, arthroscopy has been established as a standard technique in hip surgery. The potential complications of hip arthroscopy are: neurovascular traction injury, direct trauma to neurovascular structures, compression injury to the perineum, traction fixation device injury, arthroscopy-related trauma, breakage of instruments, vascular insult to the femoral head, infection, and fluid extravasations.[1,2] The development of the hemodynamically compromising abdominal compartment syndrome (ACS) after hip arthroscopy is a rare but possible and lethal complication.[1–8] Early signs of abdominal pain due to the accumulation of fluid in the abdominal cavity may be masked by regional anesthesia and sedation. Pathophysiologically, it deranges cardiovascular hemodynamics, respiratory and renal functions, and may eventually lead to multi-organ failure.[9–12] Significant progress has been made over the past decade towards understanding the etymology and pathophysiology surrounding intra-abdominal hypertension (IAH) and ACS. The absence of consensus definitions and treatment guidelines, however, has led to confusion over both the prevalence of IAH and ACS, as well as the most effective treatment strategies for such patients. Failure to recognize and appropriately treat ACS is uniformly fatal, whereas, prevention and/or timely intervention has been associated with marked improvements in organ function, and overall patient survival.[9–11] The survey experts in the field of hip arthroscopy from the Multicenter Arthroscopy of the Hip Outcomes Research Network (MAHORN) Group had determined the frequency of symptomatic intra-abdominal fluid extravasation (IAFE) after arthroscopic hip procedures. Potential risk factors had been identified among 40 cases of symptomatic IAFE. The main disadvantage of the study had been the fact that the recommended strategies of treatment were based on the experience of experts in the field of hip arthroscopy and not in the field of the World Society of the Abdominal Compartment Syndrome (WSACS). Moreover, the study had not presented a clear algorithm of treatment, which is very important to avoid mistakes in emergency treatment.
The presented case highlights the need for surgeons to be aware of this rare but serious complication, and we indicate the steps necessary to manage it promptly.
In this manuscript we aim to report a life-threatening case of primary acute ACS resulting from iatrogenic extravasation after hip arthroscopy. We also reviewed the literature and created an algorithm of treatment of ACS according to the WSACS, and additionally reviewed consensus definitions and recommendations.