Computed Tomography Findings in Intraabdominal Hypertension in Patients with Acute Pancreatitis

Gupta, Pankaj; Kamat, Rohan; Samanta, Jayanta; Mandavdhare, Harshal; Sharma, Vishal; Sinha, Saroj Kant; Dutta, Usha; Kochhar, Rakesh

doi:10.1055/s-0041-1729768

Cited by 4 publications

(3 citation statements)

References 33 publications

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“…Regarding images, Gupta et al compared imaging findings on computed tomography in patients with and without IAH. The presence of collections, maximum diameter, and volume of collection, and the presence of moderate pleural effusion were risk factors for IAH [23]. The study by Verma et al comparing the CT findings in a group of moderate and SAP with and without IAH showed that the IAH group more frequently presented pancreatic necrosis >50%, moderate-gross ascites, and the "round belly sign".…”

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

confidence: 98%

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: 98%

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

Asencio

Berger

2022

Medicina

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“…Так, сума балів згідно зі шкалою APACHE II >7, Glasgow-Imrie >3 та MODS >2 при госпіталізації пацієнта з ГП у стаціонар є прогностичним маркером розвитку АКС [33]. Також відомі візуалізаційні прогностичні (наявність помірного плеврального ексудату та гострих рідинних скупчень у черевній порожнині великого діаметра) [34] та діагностичні (>50% некротичного ураження тканини підшлункової залози, асцит, симптом "the round belly sign" -співвідношення передньозаднього та поперечного діаметрів живота, виміряного на рівні лівої ниркової вени >0,8) ознаки підвищення ВЧТ [35].…”

Section: методи діагностики підвищення вчтunclassified

Intra-Abdominal Hypertension as a Complication of Acute Pancreatitis

Kolosovych¹,

Hanol²

2023

Fiziol Zh

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The aim of our work was to review modern aspects of pathogenesis, diagnosis and treatment of intra-abdominal hypertension as a complication of the severe course of acute pancreatitis. Acute pancreatitis is a systemic disease, the severe course of which is associated with organ dysfunction and increased intra-abdominal pressure. The frequency of intra-abdominal hypertension in patients with severe acute pancreatitis is 60%, while 10-30% of patients in this category hospitalized in the intensive care unit have abdominal compartment syndrome. An increase in intraabdominal pressure has a negative effect on the course of acute pancreatitis. Namely, multiple organ failure occurs more often; pancreatic and peripancreatic necrosis, prolonged systemic inflammatory response syndrome, complications during the use of enteral nutrition, the need for invasive interventions, the length of hospitalization and the percentage of deaths increase. Determination of intra-abdominal pressure through the urinary bladder in patients with severe acute pancreatitis should be considered as a standard for diagnosing intraabdominal hypertension. It has been proven that the use of paracentesis with drainage of the abdominal cavity in the staged treatment of patients with a complicated course of acute pancreatitis (peripancreatic accumulation of fluid in the early period of the disease) reliably reduces intra-abdominal pressure after 72 h since the detection of fluid (17.4 ± 2.6 and 11.4 ± 1.6 mm Hg), serum amylase (774.3 ± 233.9 and 472.7 ± 168.6 Units/l), procalcitonin (1.3 ± 0.7 and 0.6 ± 0.5 ng/ml) and interleukin-6 (531.3 ± 120.9 and 417.1 ± 82.4 pg/ml). Achievements in intensive care, optimization of indications for surgical interventions, early enteral nutrition, rational use of liquid resuscitation and the growing role of minimally invasive interventions have had a positive effect on the prognosis of acute pancreatitis, overall morbidity and led to a decrease in deaths in this category of patients. However, the prevention and treatment of persistent intra-abdominal hypertension and abdominal compartment syndrome require further study and improvement.

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“…A computed tomography exam of the abdomen is essential for the diagnosis and grading [1], and it is effective for the accurate prediction of the progression of acute pancreatitis [70,71]. In addition, Gupta et al found that computed tomography findings such as the presence of pancreatic necrosis, abdominal collections, ascites, pleural effusions, intestinal-wall thickening (>3 mm), bowel dilation, bowel-wall enhancement, and biliary dilatation are valuable signs for the diagnosis of intra-abdominal hypertension [72]. The presence of collection, volume and maximum dimension of the fluid collections, biliary dilatation, and presence of moderate pleural effusion were CT features that were significantly associated with the presence of IAH in severe acute pancreatitis.…”

Section: Imaging Diagnosismentioning

confidence: 99%

Abdominal Compartment Syndrome in Acute Pancreatitis: A Narrative Review

et al. 2022

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Abdominal compartment syndrome (ACS) represents a severe complication of acute pancreatitis (AP), resulting from an acute and sustained increase in abdominal pressure >20 mmHg, in association with new organ dysfunction. The harmful effect of high intra-abdominal pressure on regional and global perfusion results in significant multiple organ failure and is associated with increased morbidity and mortality. There are several deleterious consequences of elevated intra-abdominal pressure on end-organ function, including respiratory, cardiovascular, gastrointestinal, neurologic, and renal effects. It is estimated that about 15% of patients with severe AP develop intra-abdominal hypertension or ACS, with a mortality rate around 50%. The treatment of abdominal compartment syndrome in acute pancreatitis begins with medical intervention and percutaneous drainage, where possible. Abdominal compartment syndrome unresponsive to conservatory treatment requires immediate surgical decompression, along with vacuum-assisted closure therapy techniques, followed by early abdominal fascia closure.

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Computed Tomography Findings in Intraabdominal Hypertension in Patients with Acute Pancreatitis

Cited by 4 publications

References 33 publications

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

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

Intra-Abdominal Hypertension as a Complication of Acute Pancreatitis

Abdominal Compartment Syndrome in Acute Pancreatitis: A Narrative Review

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