Abdominal compartment syndrome: Difference between revisions
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==Background== | ==Background== <!--T:1--> | ||
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[[File:Scheme body cavities-en.png|thumb|Lateral view showing abdominopelvic cavity.]] | [[File:Scheme body cavities-en.png|thumb|Lateral view showing abdominopelvic cavity.]] | ||
*Organ dysfunction caused by intrabdominal hypertension | *Organ dysfunction caused by intrabdominal hypertension | ||
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===Pathophysiology=== | ===Pathophysiology=== <!--T:3--> | ||
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*Abdominal perfusion pressure = MAP - intrabdominal pressure | *Abdominal perfusion pressure = MAP - intrabdominal pressure | ||
*Build up of fluid or blood within the peritoneum or retroperitoneum | *Build up of fluid or blood within the peritoneum or retroperitoneum | ||
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===Causes=== | ===Causes=== <!--T:5--> | ||
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*Acute [[Special:MyLanguage/Pancreatitis|Pancreatitis]] | *Acute [[Special:MyLanguage/Pancreatitis|Pancreatitis]] | ||
*[[Special:MyLanguage/Ascites|Ascites]] | *[[Special:MyLanguage/Ascites|Ascites]] | ||
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==Clinical Features== | ==Clinical Features== <!--T:7--> | ||
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*Most patients are critically ill and unable to communicate | *Most patients are critically ill and unable to communicate | ||
*Decreased [[Special:MyLanguage/hypotension|central venous return]] | *Decreased [[Special:MyLanguage/hypotension|central venous return]] | ||
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==Differential Diagnosis== | ==Differential Diagnosis== <!--T:9--> | ||
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==Evaluation== | ==Evaluation== <!--T:10--> | ||
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[[File:PMC3267056 jkss-81-S1-g002.png|thumb|Abdominal compartment syndrome caused by bulimia post vomiting. CT shows dilated stomach with food and air pressed other visceral organs and major abdominal vessels.]] | [[File:PMC3267056 jkss-81-S1-g002.png|thumb|Abdominal compartment syndrome caused by bulimia post vomiting. CT shows dilated stomach with food and air pressed other visceral organs and major abdominal vessels.]] | ||
[[File:PMC4972924 gr2.png|thumb|A case of abdominal compartment syndrome derived from simple elongated sigmoid colon in an elderly man.. Abdominal CT scan of the patient pre-decompression (a) and post-decompression (b). The arrow shows the inferior vena cava, which was collapsed pre-decompression.]] | [[File:PMC4972924 gr2.png|thumb|A case of abdominal compartment syndrome derived from simple elongated sigmoid colon in an elderly man.. Abdominal CT scan of the patient pre-decompression (a) and post-decompression (b). The arrow shows the inferior vena cava, which was collapsed pre-decompression.]] | ||
===Workup=== | ===Workup=== <!--T:12--> | ||
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''Physical exam is neither sensitive nor specific'' | ''Physical exam is neither sensitive nor specific'' | ||
;[https://emergencymedicinecases.com/em-quick-hits-jan2021/ Link to] steps on how to measure bladder pressure with arterial line and [https://www.youtube.com/watch?v=boknlf6cqXg video]. | ;[https://emergencymedicinecases.com/em-quick-hits-jan2021/ Link to] steps on how to measure bladder pressure with arterial line and [https://www.youtube.com/watch?v=boknlf6cqXg video]. | ||
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===Diagnosis=== | ===Diagnosis=== <!--T:14--> | ||
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*Abdominal compartment syndrome = IAH >20 mmHg PLUS end-organ damage | *Abdominal compartment syndrome = IAH >20 mmHg PLUS end-organ damage | ||
*Abdominal perfusion pressure <60 mmHg suggests abdominal hypoperfusion<ref>Al-Dorzi HM et al. Intra-abdominal pressure and abdominal perfusion pressure in cirrhotic patients with septic shock. Ann Intensive Care. 2012; 2(Suppl 1): S4.</ref> | *Abdominal perfusion pressure <60 mmHg suggests abdominal hypoperfusion<ref>Al-Dorzi HM et al. Intra-abdominal pressure and abdominal perfusion pressure in cirrhotic patients with septic shock. Ann Intensive Care. 2012; 2(Suppl 1): S4.</ref> | ||
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==Management== | ==Management== <!--T:16--> | ||
===Nonoperative=== | ===Nonoperative=== <!--T:17--> | ||
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''Often first line approach when no abdominal injury present<ref>Hunt, L., Frost, S. A., Hillman, K., Newton, P. J. and Davidson, P. M. (2014) ‘Management of intra-abdominal hypertension and abdominal compartment syndrome: a review’, Journal of Trauma Management & Outcomes, 8(1).</ref>'' | ''Often first line approach when no abdominal injury present<ref>Hunt, L., Frost, S. A., Hillman, K., Newton, P. J. and Davidson, P. M. (2014) ‘Management of intra-abdominal hypertension and abdominal compartment syndrome: a review’, Journal of Trauma Management & Outcomes, 8(1).</ref>'' | ||
*Limit fluid resuscitation | *Limit fluid resuscitation | ||
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===Operative=== | ===Operative=== <!--T:19--> | ||
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''Definitive treatment'' | ''Definitive treatment'' | ||
*Laparotomy provides decompression | *Laparotomy provides decompression | ||
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==Disposition== | ==Disposition== <!--T:21--> | ||
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*Admit | *Admit | ||
==See Also== | ==See Also== <!--T:23--> | ||
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*"Traditional" [[Special:MyLanguage/compartment syndrome|compartment syndrome]] | *"Traditional" [[Special:MyLanguage/compartment syndrome|compartment syndrome]] | ||
==External Links== | ==External Links== <!--T:25--> | ||
==References== | ==References== <!--T:26--> | ||
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<references/> | <references/> | ||
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[[Category:GI]] | [[Category:GI]] | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
[[Category:Critical Care]] | [[Category:Critical Care]] | ||
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Latest revision as of 21:30, 4 January 2026
Background
- Organ dysfunction caused by intrabdominal hypertension
- Increased intrabdominal pressure resulting in decreased organ perfusion, impaired hemodynamics
Pathophysiology
- Abdominal perfusion pressure = MAP - intrabdominal pressure
- Build up of fluid or blood within the peritoneum or retroperitoneum
- And/or decrease in abdominal wall compliance
- Increased pressure within cavity of fixed volume → hypoperfusion of abdominal organs
- Also causes restriction of diaphragmatic excursion and impaired central venous return
Causes
- Acute Pancreatitis
- Ascites
- Diffuse peritonitis
- Large volume fluid resuscitation
- Reperfusion of ischemic bowel
- Retroperitoneal hemorrhage
- Small bowel obstruction
- Trauma
Clinical Features
- Most patients are critically ill and unable to communicate
- Decreased central venous return
- Increased JVP
- Increased ICP
- Decreased cardiac preload
- Increased cardiac afterload
- Increased intrathoracic pressure
- Decreased lung compliance (will cause high peak pressures in vented patients)
- Decreased functional residual capacity
- Worsened V/Q mismatch
- Oliguria, renal failure
- Bowel ischemia
Differential Diagnosis
Abdominal Trauma
- Abdominal compartment syndrome
- Diaphragmatic trauma
- Duodenal hematoma
- Genitourinary trauma
- Liver trauma
- Pelvic fractures
- Retroperitoneal hemorrhage
- Renal trauma
- Splenic trauma
- Trauma in pregnancy
- Ureter trauma
Evaluation
Workup
Physical exam is neither sensitive nor specific
- Obtain bladder pressure
- Normal = <12 mmHg
- Intra-abdominal hypertension (IAH) = 12 - 20 mmHg
- Concern for abdominal compartment syndrome = >20 mmHg (also requires evidence of end-organ damage)
Diagnosis
- Abdominal compartment syndrome = IAH >20 mmHg PLUS end-organ damage
- Abdominal perfusion pressure <60 mmHg suggests abdominal hypoperfusion[1]
- Note that IVC scanning for volume status is especially unreliable as collapse may not represent volume depletion in the context of high intra-abdominal pressures[2]
Management
Nonoperative
Often first line approach when no abdominal injury present[3]
- Limit fluid resuscitation
- Nasogastric and bladder decompression
- Electrolyte repletion
- Antibiotics
- Pressors with goal MAP 65
- CRRT
- Percutaneous fluid drainage (remove ascites if present)
- Treat pain and adequately sedate
- Reverse Trendelenburg
- Consider metoclopramide
Operative
Definitive treatment
- Laparotomy provides decompression
- High complication rate
- No guidelines for timing of closure
Disposition
- Admit
See Also
- "Traditional" compartment syndrome
External Links
References
- ↑ Al-Dorzi HM et al. Intra-abdominal pressure and abdominal perfusion pressure in cirrhotic patients with septic shock. Ann Intensive Care. 2012; 2(Suppl 1): S4.
- ↑ Bauman Z et al. Inferior vena cava collapsibility loses correlation with internal jugular vein collapsibility during increased thoracic or intra-abdominal pressure. J Ultrasound. 2015 Dec; 18(4): 343–348.
- ↑ Hunt, L., Frost, S. A., Hillman, K., Newton, P. J. and Davidson, P. M. (2014) ‘Management of intra-abdominal hypertension and abdominal compartment syndrome: a review’, Journal of Trauma Management & Outcomes, 8(1).