OK...I am about to go off on a completely different direction...but there is a point.
Three years ago, at the age of 11, our 35 pound dog developed right heart failure from a congenital double outlet right ventricle with on obstructive pulmonary outflow tract. At her initial diagnosis, she had four liters of fluid in her abdomen drained by the veterinary cardiologist. A week later, he drained another four liters. Her condition progressively deteriorated and, over the next nine months, my girlfriend (a PICU nurse) and I drained 1.5 liters of fluid via paracentesis three times a week...
And she never developed abdominal compartment syndrome.
Sadly, we had to euthanize her because of the ongoing deterioration of her heart failure and eventual failure to respond to medication.
The point...
I agree completely with Med Mal Reviewer that two liters of fluid seems very small to cause an abdominal compartment syndrome...
It's all a bit odd. My other thought was that possibly the fluid itself was particularly caustic to the abdomen? Does urology use a special fluid when doing these procedures? It's hard to imagine that a fluid that is safe to instill into the bladder would be that dangerous in the abdomen for such a short period of time. Could the trocar have perforated the bowel and this was missed on the ex lap?
All of those thoughts make a great deal of sense to me...
Bottom line...
Yes...
I think that there are factors in the patient's situation, deterioration, and outcome that are not apparently known or clear in the facts of this case as they became known during the legal process.
Perhaps 2L was just the excess, after a much larger amount had been absorbed and distended the tissues? I might have missed what the cystoscopic total fluid deficit was. And he was also likely in much more fragile condition than the typical patient.
For hysteroscopic procedures we are taught to limit the total crystalloid fluid deficit to about 2L, maybe slightly less if the patient is very elderly or otherwise medically fragile. Most of it is expected to be absorbed intravascularly and the idea is to avoid pulmonary edema. If 2L was found in the belly, I’d think a larger amount had already been absorbed…?
OK...I am about to go off on a completely different direction...but there is a point.
Three years ago, at the age of 11, our 35 pound dog developed right heart failure from a congenital double outlet right ventricle with on obstructive pulmonary outflow tract. At her initial diagnosis, she had four liters of fluid in her abdomen drained by the veterinary cardiologist. A week later, he drained another four liters. Her condition progressively deteriorated and, over the next nine months, my girlfriend (a PICU nurse) and I drained 1.5 liters of fluid via paracentesis three times a week...
And she never developed abdominal compartment syndrome.
Sadly, we had to euthanize her because of the ongoing deterioration of her heart failure and eventual failure to respond to medication.
The point...
I agree completely with Med Mal Reviewer that two liters of fluid seems very small to cause an abdominal compartment syndrome...
No matter how thin the patient was...
Or how acute the buildup.
It's all a bit odd. My other thought was that possibly the fluid itself was particularly caustic to the abdomen? Does urology use a special fluid when doing these procedures? It's hard to imagine that a fluid that is safe to instill into the bladder would be that dangerous in the abdomen for such a short period of time. Could the trocar have perforated the bowel and this was missed on the ex lap?
All of those thoughts make a great deal of sense to me...
Bottom line...
Yes...
I think that there are factors in the patient's situation, deterioration, and outcome that are not apparently known or clear in the facts of this case as they became known during the legal process.
Perhaps 2L was just the excess, after a much larger amount had been absorbed and distended the tissues? I might have missed what the cystoscopic total fluid deficit was. And he was also likely in much more fragile condition than the typical patient.
For hysteroscopic procedures we are taught to limit the total crystalloid fluid deficit to about 2L, maybe slightly less if the patient is very elderly or otherwise medically fragile. Most of it is expected to be absorbed intravascularly and the idea is to avoid pulmonary edema. If 2L was found in the belly, I’d think a larger amount had already been absorbed…?