Abdominal compartment syndrome

Abdominal compartment syndrome may be defined as the deleterious pathophysiologic consequences of a significant increase in intra-abdominal pressure. These alterations can affect respiratory mechanics, cardiovascular system, regional blood flow, renal function, urine output, and intracranial pressure. Although the syndrome may be associated with many clinical situations, the most common are severe abdominal trauma and ruptured abdominal aortic aneurysm. Diagnosis depends upon recognition of the clinical syndrome followed by an objective measurement of intra-abdominal pressure, the most common being the measurement of bladder pressure. Treatment consists of adequate fluid resuscitation and surgical decompression when necessary.     

Abdominal compartment syndrome

Abdominal compartment syndrome (ACS) is a devastating condition for the critically unwell patient. Initially described as solely affecting surgical patients, ACS is now also recognized in the medical intensive care setting. Without prompt and definitive treatment mortality rates approach 70% as multi-organ failure develops. Over the past decade our understanding, recognition and management of ACS has evolved. The World Society of Abdominal Compartment Syndrome published updated guidelines in 2012 to draw consensus and improve patient outcomes. ACS is the end sequela of raised intra-abdominal pressure (IAP), defined as a sustained IAP >20 mmHg with or without an abdominal perfusion pressure <60 mmHg and associated with new organ dysfunction. Intravesical measuring of IAP is the gold standard diagnostic technique. Surgical decompressive laparotomy and open abdomen with temporary abdominal closure measures is the definitive treatment. This article summarizes the updated consensus definitions, pathophysiology, diagnostic investigation and management to help the junior surgical trainee faced with ACS.     

Abdominal compartment syndrome

The measurement of intra-abdominal pressure (IAP) is gaining importance in critical care units because of its prognostic value. The standard method of measurement is intravesical. When the IAP is high, the condition is referred to as intra-abdominal hypertension. The elevation may be compensated for if it is not excessive or if the increase was not rapid, or it might have various repercussions, in which case abdominal compartment syndrome (ACS) is diagnosed. The pathogenic mechanism that underlies ACS is the response of a territory predisposed to a process of ischemia and reperfusion, with release of inflammatory cytokines and formation of free radicals (anaerobic metabolism). Clinical manifestations comprise elevated IAP, oliguria, difficult mechanical ventilation with hypoxia and hypercapnia, and diminished cardiac output. ACS leads to multisystem dysfunction and, if not treated, to multiple organ failure and death. The rapid establishment of appropriate treatment measures is important. The first line of treatment is medical but definitive surgical treatment should not be delayed.     

Abdominal compartment syndrome

The abdominal compartment is limited by the abdominal wall, Mm. Psoas, vertebral column, diaphragm and the pelvis. Thus the retroperitoneum is included. Elevated intraabdominal pressure may profoundly impair the function of the entire gastrointestinal tract, the cardiovascular, respiratory, and renal system. Reduction of increased intraabdominal pressure may reverse all these adverse effects. The most common causes of elevated intraabdominal pressure are abdominal operations, abdominal trauma, diffuse peritonitis, ascites and peritoneal edema following resuscitation. Excessively increased intraabdominal pressure may result in a total loss of function and may lead to death. Such a condition is called an abdominal compartment syndrome. It usually requires operative decompression. According to animal experiments and clinical experiences suggestions for treatment are given. Diagnostic suspicion of elevated intraabdominal pressure may be confirmed with objective measurements. Since bedside manometry using a Foley catheter provides a valuable estimate of intraabdominal pressure and is easy to perform, intraabdominal pressure values may contribute to medical decision making. At this time there is a great need of controlled clinical trials to point out the importance of increased intraabdominal pressure and the abdominal compartment syndrome.     

Abdominal compartment syndrome

Abdominal compartment syndrome (ACS) is defined by the deleterious effects of intraabdominal hypertension (IAH) on the pulmonary, cardiovascular, splanchnic, urinary and central nervous system. Abnormal and sudden increase in the volume of any component of the intraperitoneal or retroperitoneal space (occurRing postoperatively or subsequent to hemorrhagic trauma, referfusion edema, penumoperitoneum, intestinal distention, acute pancreatitis...) causes IAH. Sustained IAH leads to ACS which if left unrecognized or untreated is always fatal. Measurement of urinary bladder pressure is the best validated technique for diagnosis of IAH. It should be used routinely for minimally invasive surveillance of intra-abdominal pressure (IAP) in patients with severe thoraco-abdominal trauma or after major abdominal operations. Medical management of IAH is of limited efficacy making expedient surgical decompression the treatment of choice for ACS. Surgical decompression of the abdomen and temporary closure is generally recognized as effective in clinically patent ACS but the pressure threshold indicating the need for decompression remains controversial. No data are available from controlled randomized trials and current guidelines are based on the experience of large trauma centers. The few available prospective clinical series report survival rates in the 38 to 71% range after surgical decompression for ACS. These studies are difficult to compare due to methodological features but it would appear that centers using the lowest pressure threshold for decompensation (< 20 mmHg) have the highest survival rates. Despite the available physiological arguments, indications for prophylactic temporary abdominal coverage (TAC), e.g. in trauma patients or for early decompression in IAH patients without clinical ACS, have not been validated in clinical practice. The potential morbidity of decompression procedures, TAC, and subsequent abdominal wall reconstructions require comparative studies of these treatment options with available pharmacological and non-surgical means to lower IAP.     

Abdominal compartment syndrome

Purpose  Two cases of abdominal compartment syndrome are described and the pathophysiology associated with it is reviewed. Clinical Features  The first patient was a 46-yr-old man who sustained extensive blunt abdominal injuries following a fall. The second was a 54-yr-old man involved in a motor vehicle accident with blunt abdominal trauma. In both cases, the patients developed an extremely tense abdomen, increasing peak inspiratory pressures, hypercarbia and oliguna. Both demonstrated improvement in cardiac performance and ventilatory vanables following an emergency decompressive celiotomy. Conclusion  Abdominal compartment syndrome results in impairment of organ function secondary to increased intraabdominal pressure. These patients require emergency decompressive celiotomy to relieve the symptoms. However, the incidence of intractable asystole and hypotension dunng this procedure is high and vigilance must be maintained dunng the release of the increased intraabdominal pressure.

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Résumé Objectif  Rapporter deux cas de syndrome du compartiment abdominal et revoir sa physiopathologie. éléments cliniques  Le premier patient était un homme de 46 ans souffrant de contusions abdominales multiples graves consécutives à une chute. Le deuxième était un homme de 54 ans victime d’un accident de la route et affligé d’une contusion abdominale. Dans les deux cas, l’abdomen était devenu extrêmement tendu avec augmentation des pressions respiratoires maximales, de l’hypercarbie et de l’oligurie. Une coeliotomie décompressive en urgence a permis de normaliser la performance cardiaque et les paramètres ventilatoires. Conclusion  Le syndrome du compartiment abdominal provoque un atteinte fonctionnelle organique secondaire à l’augmentation de la pression intra-abdominale. Son traitement nécessite une coeliotomie décompressive en urgence. Cependant, l’incidence d’asystolie et d’hypotension réfractaires pendant cette intervention demeure élevée. Il faut exercer une vigilance accrue au moment du relachement de la pression intra-abdominale.

     

Abdominal compartment syndrome

French physicians dealing with abdominal emergencies are not very familiar with the abdominal compartment syndrome (ACS). Increased abdominal pressure has deleterious consequences on local (intestine, liver, kidney) circulation, leading to death in the absence of correct treatment. Abdominal trauma and ruptured aortic aneurism are the main causes of ACS. Clinical presentation may be misleading: respiratory failure, oliguria or circulatory symptoms are often predominant. Abdominal palpation is inefficient for evaluating intra-abdominal pressure (IAP); only measurement of cystic pressure allows precise evaluation of IAP. Abdominal decompression is the treatment of choice. It must be performed as soon as IAP exceeds 25 mmHg. The procedure may be risky with a high incidence of severe complications when ischaemic territories are reperfused. Recent data underline the importance of compensation of hypovolemia before decompression. Abdominal closure may necessitate various techniques (aponevrotomy, Bogota bags, etc.). At any rate, IAP must remain low at the end of the procedure. In case of suspicion of ACS, early measurement of IAP is mandatory. If pressure is over 25 mmHg, a decompressive procedure must be initiated.     

腹腔筋膜室综合征

腹腔筋膜室综合征（abdominal compartment syndrome．ACS）,又称为腹腔间隙（隔）综合征、腹腔室隔综合征等。是由于各种原因造成的腹腔内压力急剧升高,影响腹腔内、外组织器官的血液循环,进而引起一系列病理生理改变所形成的一种临床综合征。临床上ACS最易累及心血管系统、泌尿系统和呼吸系统,其次是胃肠道、肝脏和中枢神经系统.     

腹腔间室综合征

腹腔间室综合征(Abdominal Compartment Syndrome,ACS)是以腹腔压力(IAP)急剧升高为特点的症侯群.常见于腹部创伤、腹膜炎、严重腹水和腹部手术后病人.……     

腹腔间室综合征22例临床分析

目的了解腹腔间室综合征(ACS)的发病特点和临床表现,探讨其治疗方法。方法总结2001年1月至2004年11月收治的ACS病人22例,其中男19例,女3例。重症急性胰腺炎11例,腹腔感染7例,腹膜后血肿3例,腹腔肿瘤1例。膀胱内压测定均>24cmH2O(1cmH2O=0.098kPa)。方法采用单纯保守治疗7例,采用手术治疗15例。保守治疗中采用气道开放、呼吸机支持18例,床边持续血液净化12例,B超或CT引导下腹腔穿刺引流8例。手术治疗中行剖腹探查、腹腔及腹膜后引流、切口减张缝合5例,腹腔探查引流后切口采用聚丙烯网片缝合覆盖行腹腔暂时开放10例。结果治愈17例,死亡5例。结论外科危重病人中并发ACS病死率高,及时诊断并采取有效的腹腔减压措施及联合多器官功能支持有助于改善病人预后。     

Abdominal compartment syndrome

Abdominal compartment syndrome (ACS) is a devastating condition for the critically unwell patient. Initially described as solely affecting surgical patients, ACS is now also recognized in the medical intensive care setting. Without prompt and definitive treatment, mortality rates approach 70% as multiorgan failure develops. Over the past decade our understanding, recognition and management of ACS has evolved. The World Society of Abdominal Compartment Syndrome published updated guidelines in 2012 to draw consensus and improve patient outcomes. ACS is the end sequala of raised intra-abdominal pressure (IAP), defined as a sustained IAP >20 mmHg with or without an abdominal perfusion pressure <60 mmHg and associated with new organ dysfunction. Intravesical measuring of IAP is the gold standard diagnostic technique. Surgical decompressive laparotomy and open abdomen with temporary abdominal closure measures is the definitive treatment. This article summaries the updated consensus definitions, pathophysiology, diagnostic investigation and management to help the junior surgical trainee faced with ACS.     

Abdominal compartment syndrome in children: experience with three cases

BACKGROUND/PURPOSE: Abdominal compartment syndrome (ACS) is defined as cardiopulmonary or renal dysfunction caused by an acute increase in intraabdominal pressure. Although the condition is well described in adults, particularly trauma patients, little is known about ACS in children. METHODS: Three girls, ages 4, 5, and 5 years, were treated for ACS by silo decompression. Each child presented in profound shock, required massive fluid resuscitation, and had tremendous abdominal distension. The first child sustained a thoracoabdominal crush injury, underwent immediate celiotomy for splenic avulsion and a liver laceration, and required decompression 5 hours postoperatively. The second underwent ligation of her bluntly transected inferior vena cava; because of massive edema, her abdominal wall could not be closed, and prophylactic decompression had to be performed. The third presented with shock of unknown etiology, and ACS developed acutely with a bladder pressure of 26 mm Hg. RESULTS: Respiratory, renal, and hemodynamic function improved immediately in all 3 patients after decompression. Subsequently, each child underwent abdominal wall reconstruction and recovered uneventfully. CONCLUSIONS: ACS is a potentially lethal complication of severe trauma and shock in children. To prevent the development of renal or cardiopulmonary failure in these patients, decompression should be considered for acute, tense abdominal distension.     

Abdominal compartment syndrome]

Abdominal compartment syndrome (ACS) is characterized by a persistent pathologic increase in intra-abdominal pressure (IAP) exceeding 20 mmHg with consecutive dysfunction of multiple organ systems. The main causes of ACS are abdominal trauma, obstruction, infection, and sepsis, but it may also be initiated by extra-abdominal diseases. The gold standard for diagnosis is repeated assessment of the IAP measurements of bladder pressure. The incidence of ACS is up to 15% in operative ICUs and the therapy of choice for it is decompressive laparotomy. Nevertheless, mortality is high, up to 60%.     

Abdominal compartment syndrome: urological aspects

ACS is prevalent in various surgical conditions and in a large percentage of critically ill patients. Measuring the IAP is important in the early diagnosis of ACS and can be easily done by measuring the intravesical pressure. ACS adversely affects many organ systems; the pathogenesis of renal dysfunction is probably multifactorial, from a combination of reduced cardiac output, reduced GFR mediated by secretion of renin and angiotensin, aldosterone-mediated water reabsorption, increased renal parenchymal pressure and direct compression of the renal vein. Successful treatment requires a high index of suspicion, prompt recognition and early surgical abdominal decompression.     

Abdominal compartment syndrome: effects on organ function

Abdominal compartment syndrome (ACS) constitutes a critical clinical situation presenting a remarkable incidence being the causal factor of variable abdominal and extra-abdominal pathology, thus a rising issue of interest in intensive medical care over the past decade. Moreover, ACS as a condition potentially leading to Multiple Organ Failure (MOF), its better understanding could provide more effective management resulting to limitation of MOF incidence and mortality.     

Abdominal compartment syndrome in the open abdomen

BACKGROUND: Multiple methods exist to manage in the intensive care unit the patient with an open abdomen. An increasingly common method is the vacuum packed technique. This method accommodates considerable expansion of intra-abdominal contents and should obviate the potential development of the abdominal compartment syndrome (ACS). Despite this, some patients with these temporary abdominal dressings will go on to develop ACS. For the purpose of this study we have defined this clinical entity as the open abdomen ACS. HYPOTHESIS: Patients with an open abdomen who develop ACS have a poor prognosis. Fluid requirements and resuscitative indices may predict which of these patients will develop open abdomen ACS. METHODS: A retrospective review was performed of patients with trauma who had an open abdomen treated with vacuum packed dressings at our urban level I trauma center. Over 1 year (July 1, 1999-June 30, 2000), 5 patients managed with an open abdomen developed ACS. These patients were compared with 15 consecutive patients with an open abdomen who did not develop clinical ACS during that same period. Fluid resuscitation, base deficit, pH, lactate level, systolic blood pressure, prothrombin time, temperature, peak inspiratory pressure, and PCO(2) were abstracted. The Fisher exact test was used for statistical analysis. RESULTS: In patients managed with an open abdomen, ACS developed between 1.5 and 12 hours (mean [SD], 7.5 [3.9] hours) after placement of the vacuum packed dressing. The base deficit, pH, peak inspiratory pressure, PCO(2,) and lactate level were more abnormal and the crystalloid requirements were significantly higher in the ACS group. The systolic blood pressure, temperature, and prothrombin time did not differ between groups. Three patients with ACS developed a second episode of ACS. Mortality in the ACS group was 3 (60%) of 5 patients vs 1 (7%) of 15 patients in the control group. CONCLUSIONS: Management of the open abdomen with the temporary abdominal closure does not prevent the development of ACS. Mortality is high when ACS occurs in this scenario. Severe physiologic derangement and high crystalloid requirements may predict which patients will develop ACS.