A case report Intra-Abdominal Hypertension Complicating Acute Pancreatitis with a Protracted Course of Severe COVID-19 Infection: A Case Report

Abstract

Introduction: The presence of intra-abdominal hypertension is common but often underappreciated in patients with severe acute pancreatitis, partly related to the effects of the inflammatory process, causing retroperitoneal edema, fluid collections, ascites, and ileus, and partly resulting from medical interventions, especially aggressive fluid resuscitation. It seems to be an early phenomenon and is associated in some patients with early multiple organ failure, like acute kidney injury, but it can also manifest at a later stage, often associated with local pancreatic complications. Case: In this case report, we detailed the management of a 30-year-old male who presented with acute pancreatitis complicated by severe intra-abdominal hypertension requiring surgical intervention and a hospital course complicated by severe COVID-19 pneumonia at the height of the COVID-19 pandemic in Uganda.Conclusion: We reported a case of AP leading to IAH, which was clinically diagnosed by a high index of suspicion, increasing abdominal distension with absent bowel sounds, and reduced urine output in a resource-limited setting where standard bladder measurement of IAH was not possible. The hospital course was protracted by the development of a hospital-acquired severe COVID-19 pneumonia as well as surgical complications of a burst abdomen and an enterocutaneous fistula. A multidisciplinary team approach, including medical and surgical teams as well as the patient’s family, was pivotal in ensuring a good patient outcome in a resource-constrained setting.