Abdominal Compartment Syndrome

DEFINITION

High intra-abdominal pressure, compromising the function of other abdominal organs.
D E A B M I M


EPIDEMIOLOGY

Usually accompanies critical illness.
D E A B M I M

AETIOLOGY

Emergency surgery

Eg AAA repair, trauma, advanced peritonitis.
- or after complications intrabdominal P may rise due to visceral oedema
- usually occurs in severely shocked, coagulopathic, hypothermic acidotic pts.
- trauma, pancreatitis, AAA, perf ulcer with severe sepsis
- also in severe burns when the abdo has not been opened.

D E A B M I M

BIOLOGICAL BEHAVIOUR

Pathogenesis
Primary
Intra-abdominal pathology directly responsible
Secondary
Progressive swelling and oedema of abdominal contents leading to raised IAP
Follows large volume resuscitation, e.g. after sepsis,

Pathophysiology
Once intra-abdominal pressure reaches above 15mmHg, progressive effects are seen on mesenteric, renal, pulmonary and ultimately cardiovascular function.
- hollow viscera and IVC are compressed
- viscous cycle of oedema to bowel wall, translocation, swelling
Above 25-30mmHg, the pt will typically become anuric, the gut will become ischaemic, metabolic acidosis ensues, and ventilation will become more difficult.
Ultimately, decreased cardiac output follows.


D E A B M I M

MANIFESTATIONS

As for the above
D E A B M I M


INVESTIGATIONS
Measure bladder pressure via a urinary catheter
- drainage tube is clamped and 50-100ml of sterile saline instilled.
- pressure tubing is connected to a tranducer at the symphysis and connected to the catheter
D E A B M I M


MANAGEMENT

Decompress with laparostomy / VAC.
Prevent by not closing an abdo that is already tight.

D E A B M I M


REFERENCES