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Abdominal compartment syndrome
From WikEM
Contents
Background
- Increased intrabdominal pressure resulting in decreased organ perfusion, impaired hemodynamics
- Also known as intrabdominal hypertension (IAH)
Causes
- Trauma
- Diffuse peritonitis
- Small bowel obstruction
- Large volume fluid resuscitation
- Retroperitoneal hemorrhage
- Reperfusion of ischemic bowel
- Acute Pancreatitis
- Ascites
Pathophysiology
- Build up of fluid or blood within the peritoneum or retroperitoneum
- And/or decrease in abdominal wall compliance
- Causes increased pressure within cavity of fixed volume
- Abdominal perfusion pressure = MAP - intrabdominal pressure
- Hypoperfusion of abdominal organs
- Restriction of diaphragmatic excursion
- Impaired central venous return
Clinical Features
- Decreased central venous return
- Increased JVP
- Increased ICP
- Decreased cardiac preload
- Increased intrathoracic pressure
- Decreased lung compliance
- Decreased functional residual capacity
- Worsened V/Q mismatch
- Oliguria, renal failure
- Bowel ischemia
Differential Diagnosis
Abdominal Trauma
- Liver trauma
- Splenic trauma
- Pelvic fractures
- Genitourinary trauma
- Retroperitoneal hemorrhage
- Renal trauma
- Ureter trauma
- Abdominal compartment syndrome
- Trauma in pregnancy
Evaluation
- Suspect ACS/IAH
- Transduce bladder pressure
- >20mmHg WITH new organ dysfunction
- Physical exam is neither sensitive nor specific
Management
Nonoperative
Often first line approach when no abdominal injury present[1]
- Limit fluid resuscitation
- Nasogastric and bladder decompression
- electrolyte repletion
- Antibiotics
- Pressors
- CRRT
- Percutaneous fluid drainage
Operative
Definitive treatment
- Laparotomy provides decompression
- High complication rate
- No guidelines for timing of closure
Disposition
- Admit
See Also
References
- ↑ 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).
