Abdominal Compartment Syndrome—When Is Surgical Decompression Needed?

Abstract

Compartment syndrome occurs when increased pressure inside a closed anatomical space compromises tissue perfusion. The sudden increase in pressure inside these spaces requires rapid decompression by means of surgical intervention. In the case of abdominal compartment syndrome (ACS), surgical decompression consists of a laparostomy. The aim of this review is to identify the landmarks and indications for the appropriate moment to perform decompression laparotomy in patients with ACS based on available published data. A targeted literature review was conducted on indications for decompression laparotomy in ACS. The search was focused on three conditions characterized by a high ACS prevalence, namely acute pancreatitis, ruptured abdominal aortic aneurysm and severe burns. There is still a debate around the clinical characteristics which require surgical intervention in ACS. According to the limited data published from observational studies, laparotomy is usually performed when intra-abdominal pressure reaches values ranging from 25 to 36 mmHg on average in the case of acute pancreatitis. In cases of a ruptured abdominal aortic aneurysm, there is a higher urgency to perform decompression laparotomy for ACS due to the possibility of continuous hemorrhage. The most conflicting recommendations on whether surgical treatment should be delayed in favor of other non-surgical interventions come from studies involving patients with severe burns. The results of the review must be interpreted in the context of the limited available robust data from observational studies and clinical trials.

Intra-Abdominal Hypertension as a Complication of Acute Pancreatitis

“…ст.) призводило до зниження ВЧТ та рівня летальності з 46 до 18% [52]. А у випадку гострого некротичного панкреатиту, з наявністю гнійно-септичних ускладнень (було проаналізовано результати лікування 47 пацієнтів, середня сума балів згідно зі шкалою APACHE II -22, 100% хворих мали сепсис, 72% -септичний шок, 85% перебували на ШВЛ, 76% мали ниркову недо статність та 68% -порушення функції печінки) застосування декомпресійної лапаротомії, некректомії, дренування черевної порожнини, зовнішньої єюностоми для ентерального харчування знижувало летальність до 8,5% (ускладнення спостерігались у 31% пацієнтів, переважно арозивні кровотечі) [53].…”

Clinical Study of Intra-Abdominal Pressure in Patients With Acute Abdominal Conditions: A Prospective Study.

“…In the context of various medical conditions such as sepsis, burns, extensive fluid resuscitation, and bowel obstructions following major abdominal surgery or peritonitis, the emergence of abdominal compartment syndrome (ACS) and intra-abdominal hypertension (IAH) presents a formidable challenge [1][2][3][4]. Notably, acute abdomen has been identified as a condition intricately linked to the pathophysiological development of IAH, with studies revealing its significant impact on organ systems and heightened rates of fatality in cases where ACS manifests with no indication of infection [5][6][7][8]. Addressing this concern, early decompression of the abdomen has been proposed as a crucial intervention.…”