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.