A minimally invasive management for abdominal compartment syndrome in severe acute pancreatitis

Han Kui Hu,Wei Ming Hu,Neng Wen Ke,Ang Li,Xiao Jiong Du

doi:10.12669/pjms.291.2721

Abstract

Three patients with severe acute pancreatitis (SAP) developed into overt abdominal compartment syndrome (ACS) and confirmed or suspected infection of necrotic tissue. We successfully treated these patients by minimally invasive decompression with the assist of laparoscope after the failures of intensive care treatments. This technique we report here may be another safe and effective management for ACS in SAP.

Highlights

Abdominal compartment syndrome (ACS) in severe acute pancreatitis (SAP) has been recognized closely related to considerable mortality rate.[1,2,3] When conservative measures fail to decrease intraabdominal pressure (IAP) and control worsening organ dysfunction, surgical intervention is needed instantly.[4]
Two-five days later of surgical intensive care unit (SICU) admission, Contrastenhanced Computed tomography (CT) confirmed the collections of fluid, and necrotic tissue in the peripancreatic area of Case 1 (Fig.1) and 3, a mass of blood and necrotic tissue in the peripancreatic area of Case 2; drainage culture confirmed the existence of gram negative bacteria in Case one, sepsis was found in Case two and three; immature neutrophils showed a growing trend, body temperature rose above 38 degrees C of the three patients; IAP ranged from 22-26mmHg; Urine output less than 160ml; tidal volume ranged from 290-340 ml; PaO2/FiO2 ranged from 158-204; Peak airway pressure (PAP) maintained more than
Management for abdominal compartment syndrome in severe acute pancreatitis conservatively approach is non-effective for ACS in SAP4; if there are evidences of infected necrotic tissue, patients may undergo debridement.[5,6]

Summary

INTRODUCTION

Abdominal compartment syndrome (ACS) in severe acute pancreatitis (SAP) has been recognized closely related to considerable mortality rate.[1,2,3] When conservative measures fail to decrease intraabdominal pressure (IAP) and control worsening organ dysfunction, surgical intervention is needed instantly.[4].

CASE REPORTS AND SURGICAL TECHNIQUE

CHE II

DISCUSSION