Abdominal Compartment Syndrome in Surgical Patients

Alex Muturi,Daniel Ojuka,Andrew Kibet,Peter Ndaguatha

doi:10.4314/aas.v14i1.10

Abstract

Background: The deleterious effects of intraabdominal hypertension and abdominal compartment syndrome, affect almost every system. Patients at risk are the critically ill, in whom it leads to alteredorgan perfusion and end organ dysfunction/failure. The five cases reported highlight the diagnostic and management challenges.Case Presentation: Five patients with variable degrees of multiple organ dysfunction/failure as evidenced by derangements in laboratory and clinical parameters are presented. Non-surgical interventions including insertion or repositioning of nasogastric tube, insertion of flatus tube, careful titration of IV fluid requirements and appropriate adjustments of ventilator setting were instituted. All five did not respond to initial management and decompressive laparotomy or re-opening of the abdomen was planned.Conclusion: Abdominal compartment syndrome can be prevented by regular measurement of intraabdominal pressure in patients at risk. Non-surgical means should precede decompressive laparotomy but timely surgical intervention is crucial.Key words: case series, Intra-abdominal pressure, Intra-abdominal hypertension, Abdominal compartment syndrome.

Highlights

If the abdominal cavity is treated as a fluid compartment, the pressure within it obeys Pascal’s hydrostatic law: when pressure is applied to a contained fluid, the force is transmitted in all directions
Pressure measured at any point within the cavity at any given time can be taken to represent Intra-abdominal pressure (IAP) in the entire abdomen [1]
Intra-abdominal hypertension (IAH) refers to a sustained or repeated pathologic elevation in IAP ≥12 mm Hg while Abdominal compartment syndrome(ACS) is defined as a sustained IAP over 20 mm Hg (with or without Abdominal perfusion pressure(APP) < 60mmHg) that is associated with new organ dysfunction/failure [1,2]

Summary

Introduction

If the abdominal cavity is treated as a fluid compartment, the pressure within it obeys Pascal’s hydrostatic law: when pressure is applied to a contained fluid, the force is transmitted in all directions. Case 1 The first case was a 45 year old man admitted in the surgical ward for alcoholic pancreatitis He was later transferred to the critical care unit(CCU) upon developing respiratory failure suspected to be adult respiratory distress syndrome (ARDS).While in CCU he had progressive abdominal distention but bowel sounds were present and he was passing stool. Case 5 The fifth patient was a 52 year old man who developed ACS following colectomy for gangrenous sigmoid colon He presented in shock with mean SBP of 72mmhg, metabolic acidosis as per the blood gas analysis which had PH 7.32,PC02 4.5kpa and HC03 at 26mmol/l and oliguria.

Discussion

Findings

Conclusion