Abdominal Compartment Syndrome in Severe Acute Pancreatitis: An Indication for a Decompressing Laparotomy?

Abstract

Background: The currently prevailing paradigm calls for non-operative management of severe acute pancreatitis for as long as there is no evidence of infection. Our purpose in presenting this anecdotal experience is to propose that there is a subset of patients who may need a laparotomy in the absence of infection in order to decompress a clinically significant abdominal compartment syndrome (ACS), which is associated with the acute pancreatitis. Methods: We present our recent experience with three patients suffering from severe acute pancreatitis. The three developed intra-abdominal hypertension (IAHT) and clinical ACS, which necessitated abdominal decompression and a laparostomy. One patient survived. Conclusions: The notion that patients with severe acute pancreatitis may develop ACS, which necessitate emergency abdominal decompression, has been ignored by current surgical literature. Only increased awareness to the syndrome of IAHT-ACS in acute pancreatitis and transvesical measurement of intra-abdominal pressure will reveal its prevalence and significance.

Surgical treatment of severe acute pancreatitis: After 15 years of practice

“…If the computed tomography scan revealed no signs of infection, diagnosis was assumed in all patients with poor clinical progression in association with inflammatory parameters elevation, such as CRP and procalcitonin. The remaining patients were surgically treated after developing abdominal compartment syndrome (9 cases) [33], multiple organ failure unresponsive to the best intensive care therapy (4 cases) or bleeding with hemodynamic instability (2 cases). A small group of patients with abdominal signs of peritoneal irritation (5 cases) were submitted to exploratory laparotomy without previous diagnosis.…”

Treatment of abdominal compartment syndrome in severe acute pancreatitis patients with traditional Chinese medicine

“…About 11% of SAP patients suffer from complications of ACS. SAP patients complicated by ACS, a special type of pancreatitis, tend to have a mortality of 66.7% [5] . There are certain guidelines for treatment of SAP, but no standard treatment for ACS Zhang MJ et al .…”

Recovery from respiratory failure after decompression laparotomy for severe acute pancreatitis

“…Indication for necrosectomy is still given in cases of infected necrosis as well as intestinal infarction, perforation or bleeding, but there is a clear trend towards surgical treatment as late and as rare as possible [2] . In contrast, more and more studies are published promoting decompression laparotomy (DL) for SAP patients developing abdominal compartment syndrome (ACS) defined by IAP greater than 20 mmHg associated with new organ failure [3][4][5][6][7] . This procedure can not only prevent critical decrement of intestinal and renal perfusion, but may lead to improvement in the respiratory situation.…”