The ratio of anteroposterior-to-transverse diameter was equal to 1:0.76. Figure 2 The images of digital subtraction angiography (DSA). The right hepatic HMPL-504 concentration artery arose from the superior mesenteric artery (SMA). (a) Celiac arteriography demonstrated contrast material extravasation from the left hepatic arterial branch (arrow). (b) Super selective DSA was confirmed leakage of the left hepatic aiterial branch. (c) PLX3397 After transcatheter arterial embolization, DSA of the celiac artery and (d) SMA did not demonstrate extravasation. Filled N-Butyl Cyanoacylate (NBCA) and Lipiodol were seen (arrowheads). Discussion ACS is a life-threatening condition resulting when the consequent abdominal swelling or peritoneal fluid

raises intraabdominal pressures (IAP) to supraphysiologic levels, in massive abdominal hemorrhage, ascites, pancreatitis, ileus, as above [1–3]. At the World Congress of ACS in 2004, the World Society

of Abdominal Compartment Syndrome, ACS is defined as an IAP above 20 mmHg with evidence of organ dysfunction/failure [4, 5]. In our case, respiratory failure had been revealed. Increased IAP causes venous stasis and arterial malperfusion of all intra-and extra-abdominal organs, resulting in ischemia, hypoxia and necrosis. In parallel, respiratory, cardiocirculatory, renal, intestinal and cerebral decompensation can be seen. Recently, ACS is divided to three types [4, 5]. Primary (postinjury) P005091 cost ACS, applied to our case, is a condition associated with injury or disease in the abdomino-pelvic region that frequently requires early surgical or interventional radiological intervention. Total body shock and subsequent reperfusion with intestinal edema and a tightly packed and closed abdomen increase abdominal pressure. Secondary ACS

refers to conditions that do not originate from the abdomino-pelvic region. The typical injury patterns are penetrating heart, major vessel, or extremity vascular trauma associated with profound shock and subsequent massive resuscitation MAPK inhibitor resulting in whole-body ischemia or reperfusion injury. Recurrent ACS represents a redevelopment of ACS symptoms following resolution of an earlier episode of either prmary or secondary ACS. Radiologically, Pickhardt et al. [1] described increased ratio of anteroposterior-to-transverse abdominal diameter over 0.8 on CT. However, Zissin [6], reported that valuable peritoneal diseases may increase this ratio without ACS, and Laffargue et al. [7] revealed that the ratio of anteroposterior-to-transverse abdominal diameter was under 0.8 in primary ACS. In our case, the ratio of anteroposterior-to-transverse diameter on CT was equal to 1:0.76 (Figure  1c). We suppose that ACS is not always completed on that time when the CT is performed to the patient with active intraabdominal hemorrhage. Therefore, we should make a diagnosis of ACS as soon as possible; the most useful and simple examination is measurement of IAP, substituted by urinary bladder pressure.