Abdominal Compartment Syndrome

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DEFINITION

High intra-abdominal pressure, compromising the function of other abdominal organs.
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EPIDEMIOLOGY

Usually accompanies critical illness.
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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.

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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.


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MANIFESTATIONS

As for the above
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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

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MANAGEMENT

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

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REFERENCES

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