Abdominal Compartment Syndrome

Abstract

The term abdominal compartment syndrome (ACS) describes the clinical manifestations of the pathologic elevation of the intra-abdominal pressure (IAP). When the IAP exceeds 12 mm Hg it is referred to as intra-abdominal hypertension (IAH) while ACS generally sets in at an IAP in excess of 20 mm Hg. This syndrome is most commonly observed in the setting of severe abdominal trauma and in the aftermath of major abdominal operations. ACS affects mainly the respiratory, cardiovascular, renal, gastrointestinal and the central nervous systems. Fundamental to the development of ACS are the obstruction of venous return to the heart via the inferior vena cava and the splinting of the diaphragm due to elevated IAP. Preventing ACS by the identification of patients at risk and early diagnosis is paramount to its successful management. To this end a high index of suspicion is sine qua non. The management of established ACS requires clinical astuteness and decisiveness with a readily available and generous team support. The purpose of this review is to enhance awareness among clinicians about a subtle condition with a devastating impact on morbidity and mortality if undiagnosed.

An Extreme Case of Lethal Abdominal Compartment Syndrome in Pediatric Patient With Synovial Sarcoma

“…In patients suspected to have elevated IAP, routine monitoring is advocated. However, these patients often have common risk factors for ACS, such as trauma, massive hemorrhage, or protracted volume resuscitation situations [ 2 ]. Intra-abdominal malignancies are a less common cause of ACS, and thus routine monitoring of IAP is not routinely done and is highly dependent on physician judgment.…”

“…There is a relative paucity of literature on ACS in children compared to adults and even less describing ACS in pediatric oncologic patients. Studies have shown that adverse effects of elevated IAP occur at lower levels than previously thought, which may be difficult to measure, and can manifest suddenly as fulminant ACS, especially in patients with intra-abdominal malignancies [ 2 ]. In particular, pediatric patients with large abdominal malignancies do not show obvious early symptoms, and many are also unable to complain about the increasing physical discomfort.…”

A rare reason of abdominal compartment syndrome: non-Hodgkin lymphoma

“…Abdominal compartment syndrome (ACS) is characterized by intra-abdominal hypertension (IAH), elevation and splinting of the diaphragm, high pleural pressure, and poor venous return to the heart, producing low cardiac output and shock which, in turn, results in poor venous return across the capillaries setting a vicious cycle. ACS and IAH affect all body systems, most notably the circulatory, respiratory, urinary and nervous [ 1 ].…”