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Refractory metabolic acidosis and acute abdominal compartment syndrome following Holmium Laser Enucleation of Prostate (HoLEP)

Murugananth Nithiyananthan

Murugananth Nithiyananthan

Singapore General Hospital, SingaporeSingapore
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Nithiyananthan, Murugananth
, 
Shitalkumar Sharad Shah

Shitalkumar Sharad Shah

Singapore General Hospital, SingaporeSingapore
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Shah, Shitalkumar Sharad
, 
Aarthi Suhitharan

Aarthi Suhitharan

National Junior College, SingaporeSingapore
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Suhitharan, Aarthi
 e 
Suhitharan Thangavelautham

Suhitharan Thangavelautham

Singapore General Hospital, SingaporeSingapore
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Thangavelautham, Suhitharan
  
31 lug 2025
Refractory metabolic acidosis and acute abdominal compartment syndrome following Holmium Laser Enucleation of Prostate (HoLEP)'s Cover Image
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Categoria dell'articolo: Case Report
Pubblicato online: 31 lug 2025
Pagine: 301 - 306
Ricevuto: 12 mar 2025
Accettato: 18 giu 2025
DOI: https://doi.org/10.2478/jccm-2025-0027
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© 2025 Murugananth Nithiyananthan et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1.

Timeline of Clinical Events in HoLEP Case. CTAP – Computed Tomography of Abdomen and Pelvis. SPC – Suprapubic Catheter.
Timeline of Clinical Events in HoLEP Case. CTAP – Computed Tomography of Abdomen and Pelvis. SPC – Suprapubic Catheter.

Fig. 2.

Comparison of Preoperative and Postoperative Chest X-rays in the patient with Abdominal Compartment Syndrome following HoLEP. The left image shows a normal preoperative chest X-ray, while the right image demonstrates postoperative abdominal distension and diaphragmatic splinting with reduced lung fields.
Comparison of Preoperative and Postoperative Chest X-rays in the patient with Abdominal Compartment Syndrome following HoLEP. The left image shows a normal preoperative chest X-ray, while the right image demonstrates postoperative abdominal distension and diaphragmatic splinting with reduced lung fields.

Fig. 3.

Abdominal CT done postoperatively on ICU admission showing fluid seepage into Extraperitoneal and Intraperitoneal Compartments. The left panel demonstrates intraperitoneal fluid (white arrow on the left) around the mesentery and bowel loops, while the right shows extraperitoneal fluid (white arrows on the right) in the retroperitoneal and perivesical spaces.
Abdominal CT done postoperatively on ICU admission showing fluid seepage into Extraperitoneal and Intraperitoneal Compartments. The left panel demonstrates intraperitoneal fluid (white arrow on the left) around the mesentery and bowel loops, while the right shows extraperitoneal fluid (white arrows on the right) in the retroperitoneal and perivesical spaces.

Arterial Blood Gas (ABG) Trends Demonstrating Severe Metabolic Acidosis Following HoLEP and Resolution Post-CRRT_

ABG parameter Intraop Day 0 Day 1 AM Day 1 PM Day 2 Day 3
FIO2 (%) 1 0.5 0.3 0.3 0.3 0.21
pH 7.102 7.141 7.211 7.398 7.412 7.441
pCO2 (mmHg) 42.2 37.6 35.9 35.8 35.6 33.9
pO2 (mmHg) 278 151.6 79.4 82.8 98.9 78.6
Base Excess (mEq/L) −16 −15.6 −12.8 −2.8 −2.1 −1.2
Bicarbonate (mEq/L) 13.2 12.7 14.5 20.6 22.6 23.4
Sodium (Na+, mEq/L) 141 136 139 138 139 139
Potassium (K+, mEq/L) 4.3 6.0 4.5 4.0 3.9 3.5
Chloride (Cl−, mEq/L) 115 115 113 109 110 105
Lactate (mmol/L) 3.3 3.2 4.8 2.7 1.7
Glucose (mmol/L) 12.1 14.9 15.9 6.6 8 7.7
Anion Gap (mEq/L) 12.8 8.3 11.5 8.4 6.4 10.6
Lingua:
Inglese
Frequenza di pubblicazione:
4 volte all'anno
Argomenti della rivista:
Medicina, Medicina clinica, Medicina interna, Medicina interna, altro, Chirurgia, Chirurgia, altro, Anestesiologia, Medicina d'urgenza e medicina di terapia intensiva
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