Computed tomography features predictive of intra-abdominal hypertension in acute necrotizing pancreatitis:  A prospective study

Verma, Suhang; Rana, Surinder Singh; Kang, Mandeep; Gorsi, Ujjwal; Gupta, Rajesh

doi:10.1007/s12664-021-01149-9

Cited by 12 publications

(8 citation statements)

References 26 publications

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“…The last consisted of an increase of >0.8 for the relation of anteroposterior/and transverse diameter of the abdomen measured at the level of the left-renal vein crossing aorta, excluding the subcutaneous fat. Although these imaging findings have not been consistently related to IAH/ACS in SAP, they deserve attention as warning signs that should prompt IAP measurement [24].…”

Section: Why Is Ap Prone To Develop Iah? Risk Factorsmentioning

confidence: 92%

Intra-Abdominal Hypertension: A Systemic Complication of Severe Acute Pancreatitis

Asencio

Berger

2022

Medicina

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Patients with severe acute pancreatitis (SAP) present complications and organ failure, which require treatment in critical care units. These extrapancreatic complications determine the clinical outcome of the disease. Intra-abdominal hypertension (IAH) deteriorates the prognosis of SAP. In this paper, relevant recent literature was reviewed, as well as the authors’ own experiences, concerning the clinical importance of IAH and its treatment in SAP. The principal observations confirmed that IAH is a frequent consequence of SAP but is practically absent in mild disease. Common manifestations of AP such as pain, abdominal distension, and paralytic ileus contribute to increased abdominal pressure, as well as fluid loss in third space and aggressive fluid replacement therapy. A severe increase in IAP can evolve to abdominal compartment syndrome and new onset organ failure. Conservative measures are useful, but invasive interventions are necessary in several cases. Percutaneous drainage of major collections is preferred when possible, but open decompressive laparotomy is the final possibility in some cases in order to definitively reduce abdominal pressure. Intra-abdominal pressure should be measured in all SAP cases that worsen despite adequate treatment in critical care units. Conservative measures must be introduced to treat IAH, including negative fluid balance, digestive decompression by gastric–rectal tube, and prokinetics, including neostigmine. In the case of insufficient responses to these measures, minimally invasive interventions should be preferred.

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Section: Why Is Ap Prone To Develop Iah? Risk Factorsmentioning

confidence: 92%

Intra-Abdominal Hypertension: A Systemic Complication of Severe Acute Pancreatitis

Asencio

Berger

2022

Medicina

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“…Imaging has been cited to assist in diagnosing IAH and ACS. The 'round belly sign' has been first mentioned in 1999, and the use of noninvasive tools to detect IAH and ACS is attractive; a recent study confirmed the predictive value of this and other computed tomography (CT)-scan characteristics (presence of moderate/gross ascites and pancreatic necrosis of >50%) in patients with severe acute pancreatitis (SAP) [19].…”

Section: The Surgical Patientmentioning

confidence: 93%

Intra-abdominal hypertension and abdominal compartment syndrome

Waele

2022

Current Opinion in Critical Care

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Purpose of reviewIntra-abdominal hypertension (IAH) has been acknowledged as an important contributor to organ dysfunction in critically ill patients, both in surgical and medical conditions. As our understanding of the pathophysiology evolves, risk factors are better recognized, preventive measures can now be implemented and therapeutic interventions tailored to the physiology of the patient. In the current review, we want to highlight developing insights in the epidemiology and treatment of patients with IAH and ACS. Recent findingsThe impact of IAH and ACS on kidney function and other outcomes continues to draw attention in recent studies. New methods for IAP measurement are under development, and the search for biomarkers to detect IAH or ACS continues. In conditions wherein IAH and ACS are common, recent studies allow better prevention and treatment of these conditions, based on the contemporary ICU management consisting of IAP measurement, judicious fluid resuscitation and decompressive laparotomy where necessary. Surgical treatment options including open abdomen therapy continue to be improved with demonstrable impact on outcomes.

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“…The development of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in acute pancreatitis (AP) portend a poor prognosis [18]. Adding to the body of literature on the ability of contrast-enhanced computed tomography (CECT) to predict the presence of IAH/ACS, Verma et al from Post Graduate Institute of Medical Education and Research, Chandigarh, India present their experience of 37 patients with AP [19]. IAH developed in 54.05% of patients who also had a significantly higher bedside index of severity in acute pancreatitis (BISAP), Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE) score, persistent acute lung injury (ALI), persistent acute kidney injury (AKI), persistent cardiovascular failure (CVSF), intensive care unit (ICU) stay, and mortality.…”

Section: Computed Tomography Features Predictive Of Intra-abdominal Hypertension In Acute Necrotizing Pancreatitis: a Prospective Studymentioning

confidence: 99%

Editorial commentary on the Indian Journal of Gastroenterology– May–June 2021

Limdi

2021

Indian J Gastroenterol

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Serum C-reactive protein and neutrophil to lymphocyte ratio as predictors of survival in cirrhotic patients with systemic inflammatory response syndrome and bacterial infection Patients with liver cirrhosis are at risk of significant morbidity and mortality from infectious complications [1]. Data on biochemical surrogates as predictors of infection are scarce. Tapadia et al. from Gleneagles Global Health City, Chennai, India assessed the predictive value of C-reactive protein (CRP) and the neutrophil-lymphocyte ratio (NLR) alone and in combination in predicting infection in a cohort of 208 consecutive hospitalized patients with cirrhosis [2].In addition to standard assessments (laboratory, ultrasound and appropriate cultures), CRP and NLR were also obtained. Investigators noted an infection rate of 62% with 58.5% culture positivity and mortality of 30.8%. Optimal cut-off values for NLR and CRP to predict infection were 5.86 and 33.7, respectively. One-month mortality risk was 2-3 times with NLR and CRP above these cut-off values. The combination of NLR + CRP (≥5.86 and ≥ 33.7) increased specificity and diagnostic accuracy for infection suggesting that these may have a role in predicting infection and even culture positivity. Prospective controlled studies are needed to validate this interesting observation.

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Computed tomography features predictive of intra-abdominal hypertension in acute necrotizing pancreatitis: A prospective study

Cited by 12 publications

References 26 publications

Intra-Abdominal Hypertension: A Systemic Complication of Severe Acute Pancreatitis

Intra-Abdominal Hypertension: A Systemic Complication of Severe Acute Pancreatitis

Intra-abdominal hypertension and abdominal compartment syndrome

Editorial commentary on the Indian Journal of Gastroenterology– May–June 2021

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