Abdominal compartment syndrome

Abdominal Compartment Syndrome (ACS) is a serious medical condition characterized by increased pressure within the abdominal cavity, which can lead to organ dysfunction and failure. It is a critical condition often encountered in the field of critical care medicine.

Pathophysiology

The pathophysiology of ACS involves the accumulation of fluid, blood, or gas within the abdominal cavity, leading to increased intra-abdominal pressure (IAP). This pressure can compromise blood flow to abdominal organs, impairing their function. The increased pressure can also affect the diaphragm, leading to respiratory compromise.

Causes

ACS can result from a variety of conditions, including:

• Trauma: Blunt or penetrating trauma can lead to bleeding and swelling within the abdomen.
• Surgery: Postoperative complications, especially after major abdominal surgery, can lead to ACS.
• Pancreatitis: Severe inflammation of the pancreas can cause fluid accumulation and increased IAP.
• Sepsis: Systemic infection can lead to capillary leak and fluid accumulation.
• Burns: Large surface area burns can cause massive fluid shifts and edema.

Risk Factors

Certain factors increase the risk of developing ACS, such as:

• Obesity: Excess body weight can increase baseline IAP.
• Massive fluid resuscitation: Large volumes of intravenous fluids can lead to edema and increased IAP.
• Hemorrhage: Internal bleeding can increase abdominal pressure.

Clinical Presentation

Patients with ACS may present with:

• Abdominal distension
• Oliguria (reduced urine output)
• Increased ventilatory requirements due to diaphragmatic elevation
• Hypotension and tachycardia
• Altered mental status

Diagnosis

The diagnosis of ACS is primarily based on the measurement of intra-abdominal pressure. This is often done using a bladder pressure measurement technique, where a catheter is inserted into the bladder and the pressure is measured as a surrogate for IAP. An IAP greater than 20 mmHg with evidence of organ dysfunction is indicative of ACS.

Management

The management of ACS involves both medical and surgical interventions:

• Medical Management: Includes optimizing fluid balance, using diuretics, and ensuring adequate ventilation and perfusion.
• Surgical Decompression: If medical management fails, surgical decompression via laparotomy may be necessary to relieve pressure.

Prognosis

The prognosis of ACS varies depending on the underlying cause, the timeliness of diagnosis, and the effectiveness of treatment. Early recognition and intervention are crucial to improving outcomes.

Prevention

Preventive strategies include careful monitoring of fluid resuscitation, early recognition of at-risk patients, and timely intervention in cases of rising intra-abdominal pressure.

See Also

• Multiple organ dysfunction syndrome
• Critical care medicine
• Intra-abdominal pressure

External links

• openabdomen.org
• wsacs.org

References

• Malbrain, M. L., et al. "Intra-abdominal hypertension: definitions, risk factors, and clinical management." Critical Care 10.2 (2006): R94.
• Kirkpatrick, A. W., et al. "Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome." Intensive Care Medicine 39.7 (2013): 1190-1206.