Acute Increase In Intra-abdominal Pressure Research Articles

Features of surgical treatment of strangulated postoperative abdominal large and giant hernias

Background. Strangulation of postoperative abdominal hernias (PAH) of large and giant size occurs in 6.2-25.1 % of cases. Elderly and senile patients predominate among patients with strangulation. The clinical course of strangulated PAH depends on the size of the hernial protrusion and its location, the nature and duration of strangulation, and the severity of comorbidities. In PAH of large and giant sizes with a multi-chamber bag, strangulation can occur in one of the chambers, which makes it difficult to diagnose. Mortality from PAH strangulation in the elderly and senile patients is 25-30 %.
 Objective. To describe the features of surgical treatment of PAH strangulation.
 Materials and methods. Analysis of literature sources on this issue.
 Results and discussion. Strangulations can be elastic, parietal, fecal and retrograde. Elastic strangulation occurs when there is an acute increase in intra-abdominal pressure, during which the hernia gate is excessively stretched, and when the intra-abdominal pressure is reduced, the organs in the hernia sac are compressed. In retrograde compression, the intestinal loop in the abdominal cavity is strangulated and necrotized. Under conditions of parietal compression, the intestinal wall opposite the mesentery is strangulated. Fecal strangulation occurs as a result of compression of the efferent loop by the overfilled afferent loop. Acute pain that occurs in the area of the postoperative scar during exercise allows to suspect PAH strangulation. For the purpose of differential diagnosis, radiography and ultrasound examination of the abdominal cavity are performed. The main principle of treatment of strangulated PAH is to carry out an urgent surgery. Short-term preoperative preparation for 2 hours is mandatory. Preoperative preparation includes detoxification (saline solutions, Reosorbilact, “Yuria-Pharm”), correction of fluid and electrolyte metabolism and disorders of the cardiovascular and pulmonary systems, prevention of thromboembolic complications. The viability of the strangulated loop is determined by its color, the condition of the mesentery, and the reaction to irritation with warm saline. If the small intestine is not viable, it is resected with removal of the afferent loop at the distance of 30-40 cm from the necrosis zone and the efferent loop at the distance of 20 cm from the necrosis zone, followed by creation of a side-to-side or end-to-end anastomosis. If the large intestine is not viable, it is resected within the above limits with the formation of colostoma. At the stages of herniotomy, hernioplasty and before drainage and suturing antiseptic washing is performed with a help of Dekasan (“Yuria-Pharm”); 800-1200 ml are used depending on the area of the wound surface. When there is a phlegmon of the hernia sac, one should perform laparotomy outside the inflammatory process, resect the necrotized organ, and then remove the hernia sac with its contents. After washing with antiseptics solutions (Dekasan) and drainage of the abdominal cavity, it is covered with the own tissues. Alloplasty is contraindicated in such cases.
 Conclusions. 1. Strangulations of PAH of big and giant sizes require urgent surgery after short preoperative preparation. 2. Surgical treatment of such strangulations should be performed with separation of the anatomical components of the abdominal wall in combination with alloplasty. 3. In case of strangulation of PAH and extremely severe condition of the patient, operation is aimed at the elimination of strangulation without defect closure.

Predictors of exploration in patients at high risk of abdominal compartment syndrome

Context Abdominal compartment syndrome (ACS) is caused when an acute increase in intra-abdominal pressure (IAP) occurs sufficient to impair vascular inflow and thereby compromising the viability of the tissues and organs within the abdomen. Familiarity with the presentation of ACS is mandatory for all clinicians who care for critically ill patients to avoid its high mortality if not recognized and treated. The measurement of IAP is a vital part of clinical management of ACS. Early recognition is important, and the need for surgical decompression may be urgent. Aim The aim was to evaluate the cases at high risk for development of ACS trying to prevent its fatal adverse effects by defining its predictors. Patients and methods This prospective, interventional, non-randomized clinical trial was conducted at Mansoura University and emergency hospitals over the period from February 2016 to February 2019. This study was conducted on patients at high risk of intra-abdominal hypertension. Two groups were included. The first group was managed conservatively, and the second one received decompressive laparotomy depending on clinical parameters, including IAP, and general status. Data were analyzed using SPSS v-24. Results A total of 40 patients who had an increased IAP greater than or equal to 20 cmH2O with several clinical presentations were included. These patients had respiratory distress (90%) and distended tense abdomen, whereas abdominal pain and oliguria were only present in ∼25% of cases. Overall, 20 (50%) patients underwent conservative management, and all these cases passed normally. Moreover, 20 (50%) patients underwent decompressive laparotomy. Univariate and multivariate analyses showed central venous pressure, BMI, urinary bladder pressure, and postoperative organ failure were found to be significant independent risk factors that increased the rate of mortality. The complications of the first group were owing to the primary operation and those of the second of group were owing to the primary operation as well as owing to operative decompression procedure. The mortality of the studied groups was 25% in the second one only, and there was a significant difference between both groups in the hospital stay. Conclusion These results had suggested that early detection of cases with ACS and proper management may be curative, and they could decrease multiorgan dysfunction and mortality in such cases. The avoidance of early abdominal closure, which may be distressing to the patients, could be mandatory in such conditions.

The Pathophysiological Hypothesis of Kidney Damage during Intra-Abdominal Hypertension.

The Pathophysiological Hypothesis of Kidney Damage during Intra-Abdominal Hypertension.

Comparison of early surgical alternatives in the management of open abdomen: a randomized controlled study.

Abdominal compartment syndrome (ACS) is a clinical syndrome characterized by progressive intraabdominal organ dysfunction resulting from an acute increase in intra-abdominal pressure (IAP). In the absence of prompt treatment, ACS can lead to lethal organ failure. Treatment of ACS is achieved by immediate decompression of the abdominal cavity. As to how and when decompression laparotomy should be performed depends on the clinical condition of the patients. There is limited data regarding outcomes of abdominal closure techiques. The present study aimed to investigate two different temporary closure methods, the vacuum assisted closure (VAC) and Bogota bag techniques, in 40 patients who underwent decompressive laparotomy as part of the management of ACS. The study included 40 patients who developed ACS during follow-up or following trauma and abdominal surgery. As part of the treatment for ACS, these patients underwent decompressive laparotomy at the Cukurova University Medical Faculty, General Surgery Department and followed up in the Intensive Care Unit of the same hospital. VAC and Bogota bag procedures were performed as temporary closure methods for the treatment of ACS. Patients were randomly assigned to each of the two groups according to the temporary closure method performed. Clinical, laboratory, mortality and morbidity results of the patients in both groups were compared. Demographic features of the patients (age, sex, body mass index, co-morbidities) were similar between the two groups. The most common reason of ACS was gastrointestinal perforation in 12 (30%) patients. Decrease in incision width was significantly faster in the VAC group than in the Bogota group. Primary closure of fascia was considered appropriate in 16.9 days in the VAC group and 20.5 days in the Bogota bag group. The decrease in abdominal pressure was similar between the two groups on days 1, 4 and 7 but appeared to be significantly lower on day 14 in the VAC group. 12 patients (30%) died during the study. Among the deceased patients, 5 (12%) were in the VAC group, whereas, 7 (17.5%) belonged to the Bogota bag group. Based on these results, it is suggested that VAC has advantages when compared to the Bogota bag as a temporary closure method in the management of abdominal compartment syndrome.

Delayed Closure Technique Using the Ventral Hernia Repair Prosthesis for a Ruptured Abdominal Aortic Aneurysm: Report of a Case

In spite of modern advances in medical care, the operative mortality of ruptured abdominal aortic aneurysm remains high at 40%-50%. Multiple organ failure is one of the reasons for the high mortality rates. An acute increase in intra-abdominal pressure and abdominal compartment syndrome are common causes of multiple organ failure.It is important to prevent abdominal compartment syndrome to improve the outcome of ruptured abdominal aortic aneurysm. Delayed abdominal closure is effective in preventing abdominal compartment syndrome in patients with ruptured abdominal aortic aneurysm. We successfully achieved delayed abdominal closure using the ventral hernia repair prosthesis for a ruptured abdominal aortic aneurysm, in a straightforward and rapid manner. No infection was seen, secondary closure was readily performed, and wound healing was good. We conclude that our delayed closure technique is useful for the treatment of ruptured abdominal aortic aneurysm.

Acute abdominal compartment syndrome complicating a colonoscopic perforation: a case report

IntroductionA perforation occurring during colonoscopy is an extremely rare complication that may be difficult to diagnose. It can be responsible for acute abdominal compartment syndrome, a potentially lethal complex pathological state in which an acute increase in intra-abdominal pressure may provoke the failure of several organ systems.Case presentationWe report a case of acute abdominal compartment syndrome after perforation of the bowel during a colonoscopy in a 60-year-old North African man with rectal cancer, resulting in respiratory distress, cyanosis and cardiac arrest. Our patient was treated by needle decompression after the failure of cardiopulmonary resuscitation. An emergency laparotomy with anterior resection, including the perforated sigmoid colon, was then performed followed by immediate anastomosis. Our patient remains alive and free of disease three years later.ConclusionAcute abdominal compartment syndrome is a rare disease that may occasionally occur after a colonoscopic perforation. It should be kept in mind during colonoscopy, especially considering its simple salvage treatment.

Intra-abdominal hypertension causes reversible blood-brain barrier disruption

Previous studies have shown that intra-abdominal hypertension (IAH) has detrimental effects on organ function and is associated with significantly increased morbidity and mortality. IAH has also been shown to increase intracranial pressure. The exact mechanism is not known. This study tests the effect of an acute increase in intra-abdominal pressure on the permeability of the blood-brain barrier (BBB) in mice. Male CD-1 mice weighing 30 g to 38 g were used. Mice in experimental groups underwent either 4 hours of IAH or 4 hours of IAH followed by 1 hour of decompression (DC). A set of control mice were anesthetized for either 4 hours or 5 hours. Femoral artery cannulation was used for blood pressure monitoring. IAH was induced by intraperitoneal infusion of mineral oil to a pressure of 20 mm Hg. DC was performed through an incision in the anterior abdominal wall. BBB integrity was determined by extravasation of 2% Evans blue (EB) dye administered through the femoral vein 1 hour before the mice were killed. BBB permeability was quantified by the EB extravasation method. EB content in brain tissue was higher in the IAH 4-hour group (n = 12) compared with their control group (n = 4; p < 0.05), indicating increased permeability of BBB. In the IAH 4-hour + DC 1-hour group (n = 6), EB content in brain tissue was not significantly higher than their respective control group (n = 6). IAH of 20 mm Hg in mice for 4 hours caused increased BBB permeability. This endothelial barrier dysfunction is reversed by abdominal DC.

Intracranial Hypertension Secondary to Abdominal Compartment Syndrome in a Girl with Giant Ovarian Cystic Mass

The abdominal compartment syndrome (ACS) is a potentially fatal entity that occurs as a result of an acute increase in intra-abdominal pressure (IAP). The authors report on a girl with a giant ovarian cystic mass, and clinical signs of ACS and intracranial hypertension (ΙΗ). The possible mechanism of IH secondary to ACS is discussed.

Abdominal compartment syndrome in children: Experience with three cases

Background/Purpose: Abdominal compartment syndrome (ACS) is defined as cardiopulmonary or renal dysfunction caused by an acute increase in intraabdominal pressure. Although the condition is well described in adults, particularly trauma patients, little is known about ACS in children. Methods: Three girls, ages 4, 5, and 5 years, were treated for ACS by silo decompression. Each child presented in profound shock, required massive fluid resuscitation, and had tremendous abdominal distension. The first child sustained a thoracoabdominal crush injury, underwent immediate celiotomy for splenic avulsion and a liver laceration, and required decompression 5 hours postoperatively. The second underwent ligation of her bluntly transected inferior vena cava; because of massive edema, her abdominal wall could not be closed, and prophylactic decompression had to be performed. The third presented with shock of unknown etiology, and ACS developed acutely with a bladder pressure of 26 mm Hg. Results: Respiratory, renal, and hemodynamic function improved immediately in all 3 patients after decompression. Subsequently, each child underwent abdominal wall reconstruction and recovered uneventfully. Conclusions: ACS is a potentially lethal complication of severe trauma and shock in children. To prevent the development of renal or cardiopulmonary failure in these patients, decompression should be considered for acute, tense abdominal distension. J Pediatr Surg 35:840-842. Copyright © 2000 by W.B. Saunders Company.

THE ABDOMINAL COMPARTMENT SYNDROME

1. ACS is caused by an acute increase in intra-abdominal pressure, usually as a result of intra-abdominal hemorrhage. 2. The most common and significant complications are respiratory and renal failure. 3. Abdominal decompression promptly reverses the complications of ACS. 4. Failure to recognize and treat ACS is inevitably fatal.

Hemodynamic effects of an acute increase in intra-abdominal pressure (IAP) in patients with cirrhosis

Hemodynamic effects of an acute increase in intra-abdominal pressure (IAP) in patients with cirrhosis

Use of a zipper to reduce intra-abdominal pressure leading to life-threatening compression of the vena cava

This is a case report of a 4-year-old child who developed protracted shock after complicated surgery for perforated appendicitis. An acute increase in intra-abdominal pressure led to compression of the inferior vena cava, reduced cardiac preload, and lowered cardiac output. Laparotomy with transient augmentation of the intra-abdominal volume using a Marlex mesh and zipper was succesfully used to overcome this life-threatening situation.