Acute abdominal compartment syndrome with pulseless electrical activity during colonoscopy with conscious sedation

We report an episode of acute abdominal compartment syndrome, with pulseless electrical activity, in a patient undergoing colonoscopic examination of a recently constructed mucus fistula. Associated clinical features of this acute abdominal compartment syndrome (tension pneumoperitoneum) were abdominal distention, which was very impressive, cardiopulmonary arrest, severe cyanosis, and progressive bradycardia. In general, increased intraabdominal pressure can have numerous adverse physiologic effects, which may include decreased cardiac output, altered ventilation-perfusion relationships, and decreased venous return. The magnitude of each effect likely depends on the magnitude of the increased intraabdominal pressure. Success with initial resuscitation efforts should not diminish further vigilance with these patients, as other problems may be discovered.