Capillary leak syndrome and abdominal compartment syndrome from occult rectal malignancy

Since its description in 1960,1 there have been fewer than 150 cases reported in the literature.3 Although it has been reported in children, it is mostly a disease of previously healthy adults.3 Histological studies suggest that endothelial damage and apoptosis are responsible for the massive vascular leakage of fluid, but attempts to find an association between serum mediators such as bradykinin, histamine, prostaglandins, interleukin-6, tumor necrosis factor-a, and vascular endothelial growth factor have been inconclusive.3 The association with monoclonal gamma globulin (paraprotein, usually IgG kappa) is present in up to 82 per cent of cases3 and only 5 per cent of the general population. In acute cases with less severe progression, treatment with terbutaline and theophylline has been used with some success.3 In addition, bevacizumab, infliximab, and thalidomide have been used with anecdotal resolution of the acute disorder.3 Overall mortality is approximately 30 per cent, but end-organ damage suggests a very poor prognosis.3 Future areas of treatment include the use of statins, tyrosine kinases, or kinase inhibitors to fortify the endothelial barrier.3