Abdominal decompression illness following repetitive diving: a case report and review of the literature

Abstract

The complete pathophysiology of decompression illness is not yet fully understood. What is known is that the longer a diver breathes pressurized air at depth, the more likely nitrogen bubbles are to form once the diver returns to surface [1]. These bubbles have varying mechanical, embolic and biochemical effects on the body. The symptoms produced can be as mild as joint pain or as significant as severe neurologic dysfunction, cardiopulmonary collapse or death. Once clinically diagnosed, decompression illness must be treated rapidly with recompression therapy in a hyperbaric chamber. This case report involves a middle-aged male foreign national who completed three dives, all of which incurred significant bottom time (defined as: “the total elapsed time from the time the diver leaves the surface to the time he/she leaves the bottom)” [2]. The patient began to develop severe abdominal and back pain within 15 minutes of surfacing from his final dive. This case is unique, as his presentation was very concerning for other medical catastrophes that had to be quickly ruled out, prior to establishing the diagnosis of severe decompression illness. After emergency department resuscitation, labs and imaging were obtained; abdominal decompression illness was confirmed by CT, revealing a significant abdominal venous gas burden.

Intraperitoneal and retroperitoneal extensive free air bubbles due to decompression illness

“…[2] In conclusion, DCI is a severe condition, presenting with a wide spectrum of symptoms depending on the system affected. [6] CT examination sensitively detects AGE and can be used to evaluate the lung parenchyma, pneumothorax, and extent of intraabdominal solid organ damage; CT also excludes other acute pathologies.…”