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 = 0.002 and p = 0.03). Total abdominal cross-sectional area decreased post-closure by 14% for both measurements (p = 0.009 and p = 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.