Intra-abdominal pressure alterations after large pancreatic pseudocyst transcutaneous drainage

Theodossis S Papavramidis,Antonis Michalopoulos,Vassilis Duros,Nick Harlaftis,Vassilis N Papadopoulos,Daniel Paramythiotis

doi:10.1186/1471-230x-9-42

Theodossis S Papavramidis, Antonis Michalopoulos + Show 4 more

Open Access

https://doi.org/10.1186/1471-230x-9-42

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Journal: BMC gastroenterology	Publication Date: Jun 6, 2009
Citations: 47	License type: CC BY 2.0

Affiliation: AHEPA University Hospital

Abstract

BackgroundAcute pancreatitis leads to abdominal hypertension and compartment syndrome. Weeks after the episodes pancreatic fluids sometimes organize to pseudocysts, fluid collections by or in the gland.Aims of the present study were to evaluate the intra-abdominal pressure (IAP) induced by large pancreatic pseudocysts and to examine the effect of their transcutaneous drainage on IAP.MethodsTwenty seven patients with a pancreatic pseudocyst were included. Nine patients with pseudocysts greater than 1l (group A) had CT drainage and eighteen (volume less than 1l) were the control group. The measurements of group A were taken 6 hours before and every morning after the drainage, while for group B, two measurements were performed, one at the day of the initial CT and one 7 days after. Abdominal compliance (Cabd) was calculated. Data were analyzed using student's t-test.ResultsBaseline IAP for group A was 9.3 mmHg (S.D. 1.7 mmHg), while the first post-drainage day (PDD) IAP was 5.1 mmHg (S.D. 0.7 mmHg). The second PDD IAP was 5.6 mmHg (S.D. 0.8 mmHg), the third 6.4 mmH (S.D. 1.2 mmHg)g, the fourth 6.9 mmHg (S.D. 1.6 mmHg), the fifth 7.9 mmHg (S.D. 1.5 mmHg), the sixth 8.2 mmHg (S.D. 1.4 mmHg), and the seventh 8.2 mmHg (S.D. 1.5 mmHg). Group B had baseline IAP 8.0 mmHg (S.D. 1.2 mmHg) and final 8.2 mmHg (S.D. 1.4 mmHg). Cabd after drainage was 185.6 ml/mmHg (SD 47.5 ml/mmHg).IAP values were reduced between the baseline and all the post-drainage measurements in group A. IAPs seem to stabilize after the 5th post-drainage day. Baseline IAP was higher in group A than in group B, while the two values, at day 7, were equivalent.ConclusionThe drainage of large pancreatic pseudocyst reduces IAP. Moreover, the IAP seems to rise shortly after the drainage again, but in a way that it remains inferior to the initial value. More chronic changes to the IAP are related to abdominal cavity's properties and have to be further studied.

Highlights

Acute pancreatitis leads to abdominal hypertension and compartment syndrome
It is well known that acute pancreatitis is one of the most frequent reasons leading to abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) [58]
In order to prevent the accumulation of multiple pathologies and the off-balancing of Intra-abdominal pressure (IAP) towards IAH and ACS, we believe that large pancreatic pseudocyst drainage has to be done as early as possible

Summary

Introduction

Acute pancreatitis leads to abdominal hypertension and compartment syndrome. Weeks after the episodes pancreatic fluids sometimes organize to pseudocysts, fluid collections by or in the gland. Intra-abdominal pressure (IAP) is the pressure maintained in the abdominal cavity. It can be measured using various techniques, but the most used and the easiest to apply is the transvesical [1,2,3]. It is well known that acute pancreatitis is one of the most frequent reasons leading to abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) [58]. After the acute episode of pancreatitis, free pancreatic fluids sometimes organize weeks after the episodes, to pseudocysts. Pancreatic pseudocysts are pancreatic fluid collections by or in the gland. The size of the pseudocysts varies from small (6 cm), mirroring the amount of fluid contained in the cyst

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Discussion

Conclusion