Loss of abdominal domain: Is it the abdominal wall or contents?

Abstract

Background: Intra-abdominal hypertension and abdominal compartment syndrome are significant sources of morbidity and mortality in the post-surgical and trauma patient. Several anatomic variables may contribute to the inability to close the abdomen such as retraction of the abdominal wall and intra-abdominal volume changes. This study seeks to quantify these changes and determined which predominates. Methods: Retrospective analysis of computed tomography scans of patients whose abdomens could not be closed secondary to intra-abdominal hypertension. Patients were included who had computed tomography scans available with both an open abdomen and after primary abdominal wall closure. Abdominal wall lengths along with total abdominal, intra-peritoneal, and retroperitoneal cross-sectional areas were measured at two anatomic levels. Results: Seven patients' computed tomography scans were evaluated. The closed abdominal wall lengths averaged 2.3 cm and 2.1 cm longer after closure at each point of measurement (p ¼ 0.002 and p ¼ 0.03). Total abdominal crosssectional area decreased post-closure by 14% for both measurements (p ¼ 0.009 and p ¼ 0.04). Conclusion: Measurable increases in intra-abdominal cross-sectional area and decreases in abdominal wall length both contribute to the inability to safely close the abdomen in patients with intra-abdominal hypertension. These findings support the use of multimodal techniques in the management of the open abdomen.