Abstract

Background: Abdominal compartment syndrome (ACS) occurs in critically sick patients and is defined as intra-abdominal pressure (IAP) over 20mmHg accompanied by new-onset organ dysfunction [1]. ACS necessitates emergent therapy to decrease abdominal pressures-whether it be via surgical means, or in the case of our patient, paracentesis [1].

Case presentation: A 60-year-old male with a medical history of coronary artery disease status post coronary artery bypass graft and hypertension presented to the Emergency Department (ED) with shortness of breath of 2 days duration preceded by three weeks of increasing abdominal pain and lower extremity edema. He was found to have large ascites and extensive lymphadenopathy on computed tomography (CT) of the abdomen and pelvis. He went for emergent paracentesis and 13,500mL of chyle was removed from the peritoneum. He was eventually diagnosed with non-Hodgkin’s lymphoma (NHL) and started on chemotherapy. Unfortunately, he expired four months later due to a cardiac arrest at home.

Conclusion: Although ACS is more classically caused by trauma and/or bleeding, severe liver cirrhosis, ileus, excessive fluid resuscitation or transfusion, it can also be caused by any process that increases IAP [1]. ACS has been reported due to a retroperitoneal mass from NHL but has not yet been described as a complication of malignant chylous ascites [2]. Here, we report the first case of ACS caused by chylous ascites in the setting of newly diagnosed NHL

Keywords: Abdominal compartment syndrome (ACS); Non-Hodgkin’s lymphoma (NHL); Chylous ascites; Malignancy