Abdominal compartment syndrome
| Abdominal compartment syndrome | |
|---|---|
| Specialty | Emergency medicine  |
Abdominal compartment syndrome (ACS) occurs when the
Causes
- Peritoneal tissue edema secondary to diffuse peritonitis, abdominal trauma[7]
- Fluid therapy due to massive volume resuscitation
- Retroperitoneal hematoma secondary to trauma and aortic rupture
- Peritoneal trauma secondary to emergency abdominal operations
- Reperfusion injury following bowel ischemia due to any cause
- Retroperitoneal and mesenteric inflammatory edema secondary to acute pancreatitis[8]
- Ileus and bowel obstruction
- Intra-abdominal masses of any cause
- Abdominal packing for control of bleeding
- Closure of the abdomen under undue tension
- Ascites (intra-abdominal fluid accumulation)[9]
- Acute pancreatitis with abscesses formation
Pathophysiology
Abdominal compartment syndrome occurs when tissue fluid within the
Abdominal compartment syndrome follows a destructive pathway similar to compartment syndrome of the extremities. When increased compression occurs in such a hollow space, organs will begin to collapse under the pressure. As the pressure increases and reaches a point where the abdomen can no longer be distended it starts to affect the cardiovascular and pulmonary systems. When abdominal compartment syndrome reaches this point without surgery and help of a silo the patient will most likely die. There is a high mortality rate associated with abdominal compartment syndrome.[4][11]
Diagnosis
Abdominal compartment syndrome is defined as an intra-abdominal pressure above 20 mmHg with evidence of organ failure. Abdominal compartment syndrome develops when the intra-abdominal pressure rapidly reaches certain pathological values, within several hours (intra-abdominal hypertension is observed), and lasts for 6 or more hours. The key to recognizing abdominal compartment syndrome is the demonstration of elevated intra-abdominal pressure which is performed most often via the urinary bladder, and it is considered to be the "gold standard". Multiorgan failure includes damage to the cardiac, pulmonary, renal, neurological, gastrointestinal, abdominal wall, and ophthalmic systems. The gut is the most sensitive to intra-abdominal hypertension, and it develops evidence of end-organ damage before alterations are observed in other systems.[12] In a recent systematic review, Holodinsky et al. described 25 risk factors associated with IAH (intra-abdominal hypertension) and 16 with ACS (abdominal compartment syndrome). These can be roughly categorized in three categories, which may be more helpful at the bedside to identify patients at risk (Table 1). Especially noteworthy is the potential role of fluid resuscitation in the development of IAH and ACS. Recognizing the pivotal role of fluid resuscitation in the pathogenesis of IAH and ACS supplies the clinician with a target for preventive measures. Large volume resuscitation with crystalloids should be avoided in patients with or at risk of ACS.[13]
| Abdominal catastrophes | Severe organ dysfunction | Fluid balance |
|---|---|---|
| Trauma, peritonitis, acute pancreatitis, ruptured abdominal aortic aneurysm
Often post-surgery |
Metabolic respiratory renal hemodynamic | >3000–4000 mL in 24 h window |
Treatment
Operative decompression
The mortality rate associated with abdominal compartment syndrome is significant, ranging between 60% and 70%. The poor outcome relates not only to abdominal compartment syndrome itself but also to concomitant injury and hemorrhagic shock.
