Abdominal compartment syndrome


Lateral view showing abdominopelvic cavity.
  • Organ dysfunction caused by intrabdominal hypertension
  • Increased intrabdominal pressure resulting in decreased organ perfusion, impaired hemodynamics


  • 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


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 caused by bulimia post vomiting. CT shows dilated stomach with food and air pressed other visceral organs and major abdominal vessels.
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.

Physical exam is neither sensitive nor specific

  • Obtain bladder pressure
    • Normal < 12 mmHg
    • Intra-abdominal hypertension 12 - 20 mmHg
    • Abdominal compartment syndrome > 20 mmHg PLUS end-organ damage
    • Link to steps on how to measure bladder pressure with arterial line and video.
  • 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]



Often first line approach when no abdominal injury present[3]


Definitive treatment

  • Laparotomy provides decompression
    • High complication rate
    • No guidelines for timing of closure


  • Admit

See Also

External Links


  1. 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.
  2. 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.
  3. 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).