Abdominal compartment syndrome after endoscopic combined intrarenal surgery.

INTRODUCTION: We report a case of abdominal compartment syndrome due to hydroperitoneum after endoscopic combined intrarenal surgery.

CASE PRESENTATION: A 56-year-old woman with a left staghorn calculus underwent endoscopic combined intrarenal surgery as a two-staged procedure and developed a distended abdomen, cyanosis of both legs, and hypotension immediately after the second operation. A computed tomography scan showed hydroperitoneum. We performed urgent laparotomy and evacuated approximately 2 L of nearly transparent fluid. No peritoneal injury was detected. Postoperatively, she required intensive care for shocked liver and acute kidney injury.

CONCLUSION: Hydroperitoneum after endoscopic combined intrarenal surgery is a rare complication and may lead to abdominal compartment syndrome or a condition where intra-abdominal pressure exceeds 20 mmHg, causing impaired organ perfusion. Delayed drainage can be fatal.