Occurrence Of Abdominal Compartment Syndrome Research Articles

Surgical Intervention Strategies of Necrotizing Pancreatitis With Abdominal Compartment Syndrome.

ObjectiveAcute pancreatitis can usually recover after conservative treatment. Five to 10 percent of acute pancreatitis may proceed into peripancreatic fluid collection and necrosis development, called necrotizing pancreatitis (NP), which has a high mortality rate. If it is accompanied by the occurrence of abdominal compartment syndrome (ACS) and does not respond to medical therapy, surgical intervention is indicated.MethodsWe analyzed our experience of surgical intervention strategies for NP patients with medically irreversible ACS from January 1, 2004, to December 31, 2018.ResultsOf the 47 NP patients with ACS, mean Ranson score was 6.5, mean Acute Physiology and Chronic Health Evaluation II score was 22.2, and Modified computed tomography severity index score was all 8 or greater. The mean total postoperative hospital length of stay was 80.2 days, of which the mean intensive care unit length of stay was 16.6 days. The overall complication rate was 31.9%. The mortality rate was 8.5%. Among the 47 patients, only fungemia was significantly associated with mortality incidence.ConclusionsThe combination of multiple drainage tube placement, feeding jejunostomy, and ileostomy at the same time were effective surgical intervention strategies for NP patients with ACS, which brought a lower mortality rate.

Hydrops fetalis and neonatal abdominal compartment syndrome continuum from immature gastric teratoma: a case report

BackgroundHydrops fetalis as well as abdominal compartment syndrome (ACS) are conditions that are associated with high mortality rates. A rare case of immature gastric teratoma causing fetal hydrops and subsequent ACS is presented. The related pathophysiologic mechanisms are discussed, and the importance of timely recognition and appropriate interventions are highlighted.Case presentationThe male patient was born preterm, weighing 3.9 kg., by Cesarean section. Prior prenatal ultrasounds were normal, but a scan done just before delivery had findings indicating polyhydramnios, fetal ascites, and meconium peritonitis. Upon delivery, the patient had respiratory distress, anasarca and a massively distended abdomen. Resuscitation measures, including ventilatory support, were instituted. Imaging studies showed ascites as well as a large, complex intra-abdominal lesion with calcifications. In the succeeding hours, anuria persisted, anasarca worsened, the abdomen became more distended, and inotrope requirements increased. The occurrence of ACS, from what was presumed to be a retroperitoneal teratoma, was therefore considered. Laparotomy was done on the 28th hour of life, with en bloc excision of a massive tumor and attached section of the greater curvature of the stomach. Passage of urine occurred intra-operatively, and the patient was soon after weaned off inotropes and ventilator support. The histopathologic result was immature gastric teratoma. No chemotherapy was given, and the patient’s serum AFP is at normal levels 15 months following surgery.ConclusionThe presence of a massive intra-abdominal lesion can result in the pathophysiologic continuum of hydrops fetalis and neonatal ACS. The early recognition of such an association can enable appropriate expectant management of similarly affected neonates, including emergent decompression laparotomy.

Early Initiation of Renal Replacement Therapy Among Burned Patients With Acute Kidney Injury.

Burned patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT) have exceedingly high mortality rates of 73% to 100%. Since January 2011, we have been adopting an early RRT approach in managing burned patients with AKI. Our hypothesis was that early initiation of RRT leads to improved outcome and survival among burned patients with AKI. We conducted a retrospective analysis of Burns Database in Singapore General Hospital from January 2011 to February 2016. Indications for dialysis included serum creatinine of greater than 1.5 times baseline or urine output of less than 0.5 mL/kg per hour for at least 6 consecutive hours. Patients with similar condition from January 2006 to December 2010 were recruited for comparison. A total of 27 patients with burns and AKI were recruited from January 2011 to February 2016. The mean age was 45.4 years and 88.9% were male. The mean total burn surface area (TBSA) was 54.8%. The total volume of fluid resuscitation was 2.7 mL/kg per TBSA. The time from onset of burn to RRT was 6.4 days. Most patients presented with stage 1 AKI (51.9%), whereas 22.2% and 25.9% had stage 2 and stage 3 AKI, respectively. Most patients (74.1%) received CRRT and 18.5% received SLED. The mortality rate was 37.0% with majority of death (70%) due to sepsis/multiorgan failure. Only 1 patient required long-term RRT after discharge, and there was no occurrence of abdominal compartment syndrome. The mean age of 15 patients from 2006 to 2010 was 47.8 years. The mean TBSA was 49.5%. Only 26.7% of patients were started on RRT. The mortality rate was 66.7%, which was higher than that of subjects from 2011 to 2016 (37.0%) (P = 0.039). Optimal timing of RRT for burned patients with AKI has not been established and data on early RRT approach are scarce. The findings of our study suggested that early RRT was associated with lower mortality rates among burned victims with AKI.

IMPROVEMENT OF TECHNOLOGIES OF DIAGNOSTICS AND TREATMENT OF INTRA-ABDOMINAL HYPERTENSION IN ACUTE SURGICAL PATHOLOGY OF ABDOMINAL CAVITY

Relevance. The article is devoted to the problem of diagnosis and treatment of intra-abdominal hypertension (IAH) in acute abdominal pathology. Acute surgical diseases and abdominal injuries are accompanied by an increase in intra-abdominal pressure (IAP) in 83.6% of cases, and cause an abdominal compartment syndrome (ACS) in 16.8% of the observations.
 Objective. This review seeks to improve the results of treatment of patients with acute abdominal pathology by improving the methods of diagnosis, prevention and treatment of IAH.
 Materials and methods. The results of treatment of 187 patients with acute pathology of abdominal organs, which was accompanied by high IAP, were analyzed. Among the 187 patients, 98 (52.4%) were men, 89 (47.6%) women. The patients were divided into two groups depending on the diagnostic and therapeutic tactics chosen: the comparison group (85 (45.5%) persons) and the main group (102 (54.5%) persons). The treatment of them were carried out in accordance with our harmonized diagnostic and treatment algorithm of the correction of IAH. 149 (79.7%) patients were operated: 82 patients in the main group and 67 persons in comparison group. Our own method for the long-term determination of IAP by measuring it in the bladder was used for long-term diagnostics of IAP. Advanced laparolifting system was used in the complex conservative treatment of patients with acute pancreatitis accompanied by IAH. Methods for predicting the possibility of performing laparoscopic intervention in urgent surgery and postoperative pain after laparoscopic surgery were improved.
 Results. Implementation of the improved method of measuring IAP through prolonged monitoring of BP allowed to timely select and start the necessary therapeutic tactics, aimed to overcome intra-abdominal hypertension, and to avoid the development of abdominal compartment syndrome (sensitivity of the technique was 95.2%, specificity - 85.7%). The use of our advanced diagnostic and treatment algorithm for the prevention and treatment of IAH allowed to limit the measures to the first level in 67,6% of cases, to the second level - in 22,5% and to avoid the decompression laparostomy. At the same time, the need for such intervention arose in 11.1% of patients who had conservative treatment.
 Use of the proposed laparolifting system in the complex conservative treatment of IAH of patients with acute pancreatitis allowed to normalize IAP in the vast majority of patients, preventing the occurrence of ACS by reducing the frequency of complications associated with IAH, from 52.9% to 16.7% (p = 0.03 ), as well as overall mortality - from 35.3% to 5.6% (p = 0.03). Implementation into clinical practice the method of predicting the possibility of performing laparoscopic intervention in the conditions of urgent surgery by registering the initial values ​​of IAP, allowed to expand the indications for the implementation of this type of surgery in treatment of acute surgical pathology of the abdominal cavity organs (sensitivity of the technique was 85.7%, specificity - 95.5%). Local use of stereoselective NSAIDs (original dexketoprofen) at the end of the laparoscopic intervention followed by their intramuscular administration has a higher analgesic effect in comparison with other classes of analgesic agents, which is reliably confirmed by pain assessment indicators (visual analogue scales, blood plasma cortisol and external respiration function) (p <0.0001), and has a significantly higher degree of safety (p <0.001). Application of the proposed diagnostic and treatment algorithm in the complex treatment of patients with acute surgical pathology of the abdominal cavity, which is accompanied by IAH, allowed to achieve the intended goal for improving the treatment results of this category of patients by reducing the incidence of systemic complications from 54.1% to 11.8% ( p <0.0001), total mortality from 21.2% to 1.96% (p <0.0001), and postoperative lethality from 22.4% to 2.4% (p = 0.0001).
 Conclusions. The method of measuring IAP by prolonged monitoring of BP is effective and practical (sensitivity of the technique was 95.2%, specificity - 85.7%). The use of the laparolifting system in patients with acute pancreatitis accompanied by IAH allowed to reduce the frequency of complications from 52.9% to 16.7% (p = 0.03), and the overall mortality - from 35.3% to 5.6% (p = 0,03). The introduced method of predicting the possibility of performing laparoscopic intervention in urgent surgery demonstrates high sensitivity (85.7%) and specificity (95.5%). The local use of stereoslective NSAIDs at the end of the laparoscopic intervention has a high analgesic effect and has a significantly higher safety degree (p <0.001). The use of the advanced diagnostic and treatment algorithm for treatment of IAH allows to apply only the first level measures in 67,6% of cases, the second level measures in 22,5%, to avoid the implementation of decompression laparostomy and to reduce the incidence of systemic complications from 54,1% to 11,8% (p <0.0001), to reduce total mortality from 21.2% to 1.96% (p <0.0001) and postoperative lethality from 22.4% to 2.4% (p = 0.0001).

Application and progress of initiative content reduction surgery in the treatment of large ventral hernia

Currently, the number of abdominal surgery has gradually increased, accompanied by the increasing of ventral hernia and parastomal hernia patients. The main reason is abdominal incision or abdominal stoma destroying the normal abdominal muscle fascia, as well as obesity, malnutrition, ascites, diabetes, infections leading to poor wound healing. The incidence of abdominal wall incisional hernia after abdominal surgery accounts for about 80% of ventral hernia. These incisional hernias and some other ventral hernias may easily become large ventral hernia without the standard treatment. Surgery is the only effective treatment for large ventral hernia. However, such hernia repair for surgeons is a great challenge. In clinical practice, after removing the huge sac and completely resetting the contents of the hernia sac can lead to decreasing of intraperitoneal volume and increasing of intra-abdominal pressure, or even lead to occurrence of abdominal compartment syndrome (ACS). The increasing of intra-abdominal pressure and occurrence of ACS has aroused the attention of clinicians after large ventral hernia operation. Some content reduction operation in the process of large ventral hernia surgery can effectively reduce postoperative intra-abdominal pressure, occurrence of intra-abdominal hypertension and ACS. More and more patients with large ventral hernia underwent the abdominal content reduction surgery combined with hernia repair. But there is still lack of evidence-based medical researches on large simples. Therefore, it still needs multi-center prospective clinical study on large samples to provide clinical treatment strategies for the volume reduction surgery and more base for further researches and clinical applications. Key words: Initiative content reduction; Large ventral hernia; Abdominal compartment syndrome; Intra-abdominal hypertension

Role of Components Separation in War-Related Pediatric Abdominal Trauma

INTRODUCTION: Trauma and reconstruction surgeons in the deployed military theater are often exposed to devastating and significant pediatric war-related injuries.1 While extremity and craniofacial injuries are important considerations in the care of these children, the associated abdominal injuries secondary to penetrating ballistics and blast exposure can be immediately life-threatening, and careful management of such abdominal injuries are critical in the impact of survival for these children. The purpose of this review is to report our collective experience in managing pediatric abdominal trauma within the austere, battlefield environment with careful considerations to lessons learned during the last decade of war-related pediatric trauma. METHODS: A retrospective review of war-related pediatric trauma treated at the Role 3 Multinational Medical Unit, Kandahar, Afghanistan from October 2010 through January 2013 was reviewed. Data assessed included the severity of abdominal trauma, associated thoracic, perineal, extremity, and craniofacial injuries. Average surgical times, time to definitive abdominal closure and method of definitive closure, and complications were reviewed and reported. RESULTS: Of 383 pediatric patients treated, 41 cases were classified “thoracic” and 15 were classified as “abdominal.” The mechanism of injury was blast in the majority of cases. Component separation technique (CST) was performed on two pediatric patients, 12 months and 9 years of age, after traumatic war-related abdominal injury. There was no mortality in this series. The nine year old patient was discharged without complication or further intervention. The 12 month old patient developed a small bowel leak at the site of anastomosis, requiring re-exploration but primary fascial apposition was achieved at the end of the re-exploration without issue. The patient was discharged without further complication. CONCLUSION: The last decade of war trauma has presented our military surgeons with a high volume of complex abdominal injuries including a significant experience in pediatric war-related penetrating and blast injuries. We successfully performed CST on pediatric patients with minimal complications and no occurrence of abdominal compartment syndrome. CST should be considered to treat traumatic ventral hernias in a pediatric population.

Tapping for pneumoperitoneum in neonates and infants

Purpose The aim of this study was to shed some light on the presence of pneumoperitoneum in neonates and infants and to present and evaluate our method for its treatment. Materials and methods This study included 33 patients diagnosed with pneumoperitoneum during 2004–2011, of whom 19 were girls and 14 were boys, and their ages ranged from 1 week to 5 months; 21 patients were neonates and seven of them were premature; two were aged less than 32 weeks and had mild pneumoperitoneum, which could be treated conservatively and five were aged between 32 and 34 weeks. Tapping was performed for all patients. Tapping can help in selection of patients with necrotizing enterocolitis needing exploration when the aspirate is bilious or feculent. Tapping could be performed as a temporary measure before exploration to decrease respiratory distress and the occurrence of abdominal compartment syndrome and also as a routine procedure in patients with pneumoperitoneum. Tapping is an easy procedure and can be performed with the patient in bed or in the incubator. Pneumoperitoneum is not an absolute indication for surgical exploration and a small subset of patients should be managed by laparotomy. Each patient with pneumoperitoneum should be assessed and categorized for tapping, placement of a tube drain, or surgical exploration. Pneumoperitoneum occurs in neonates more frequently than in infants, and most cases are idiopathic. Results A total of 29 patients were treated by tapping alone (in nine patients, tapping was performed once; in 13, it was performed twice, and in the other seven, it was performed three to four times). Rapid improvement in the general condition and respiratory distress occurred in most patients. Six patients (five neonates and one infant) were explored because of: (a) aspiration of a bile-stained or feculent fluid in two patients and (b) failure of conservative treatment in four patients. Conclusion Pneumoperitoneum occurs in neonates more than infants and most cases are idiopathic. Each case of pneumoperitoneum should be assessed and categorized for tapping, placement of a tube drain or surgical exploration. Pneumoperitoneum is not an absolute indication for surgical exploration and small subset of patients should be managed by laparotomy. Tapping is an easy job and can be done with the patient in bed or in the incubator. Tapping could be performed as a routine in cases of pneumoperitoneum. Tapping could be done as a temporary measure before exploration to decrease respiratory distress and abdominal compartment syndrome.

Delayed closure technique for a ruptured abdominal aortic aneurysm: Report of three cases

This report describes three cases of a delayed closure to prevent the occurrence of abdominal compartment syndrome (ACS) in patients presenting with ruptured abdominal aortic aneurysms (rAAA). The delayed closure technique is useful for rAAA in order to prevent ACS.

A rare and unsuspected complication of Clostridium difficile infection

To report the occurrence of abdominal compartment syndrome (ACS) due to infection with Clostridium difficile. Case report. Trauma intensive care unit (TICU) of Hamad General Hospital, a teaching hospital in Doha, Qatar. A 36-year-old man involved in a motor vehicle accident had severe traumatic brain injury and received ceftriaxone. On day 7, he developed severe abdominal distension and diarrhoea followed by paralytic ileus with oliguria, hyperkalaemia, and intra-abdominal hypertension. The patient's stool sample was positive for C. difficile toxin A and B MEASUREMENTS AND RESULTS: An ACS was diagnosed. The patient was successfully treated in the TICU by stopping the offending antibiotic and starting metronidazole plus neostigmine as a prokinetic agent. The fluid status was guided by pulse-induced continuous cardiac output, and frusemide was added to the treatment. With this aggressive management the abdominal pressure decreased and the renal function improved, with full recovery of renal function by day 21. Unfortunately the patient's Glasgow coma score (GCS) deteriorated, so percutaneous tracheostomy was performed. He was transferred to the neurosurgical ward on day 35. A week later he was shifted to the rehabilitation unit for further management. C. difficile colitis can cause intra-abdominal hypertension (IAH) and ACS. Rapid diagnosis, early aggressive supportive care, metronidazole and prokinetics are necessary to lower the morbidity and mortality of C. difficile colitis associated with IAH and ACS.

OUTCOMES OF CHILDREN WITH ABDOMINAL COMPARTMENT SYNDROME

Introduction: Abdominal compartment syndrome (ACS) is a problem across all critical care scenarios and is associated with a high mortality. It has not been well described in pediatric populations.Objective: To describe the occurrence of ACS in a subset of critically ill pediatric patients and determine its effects on mortality and length of pediatric intensive care stay (PICU LOS). We also aimed to find predictors of mortality and development of ACS.Setting: 25 bed tertiary pediatric intensive care unit.Patients: Patients less than 50 kg on mechanical ventilation and a urethral catheter.Measurements: Intra-abdominal pressures (IAP) were monitored using the intra-vesical technique. ACS was defined as IAP of >12mmHg associated with new organ dysfunction or failure. Demographics, physiologic measures of organ dysfunction, PICU LOS and mortality were monitored.Main Results: 14 (4.7%) of 294 eligible patients had ACS. Mortality was 50% among those with ACS versus 8.2% without (p<.001). PICU LOS stay did not differ between groups. No difference in mortality or PICU LOS was seen in primary versus secondary ACS or in patients who underwent abdominal decompression compared to those without decompression. IAP and ACS were independent predictors of mortality (odds ratio 1.53, 95% CI, 1.17 – 1.99 and 9.09, 95% CI, 1.07 - 76.84) respectively. IAP and a PRISM score of ≥17 were predictive of developing ACS.Conclusions: ACS is a clinical problem that increases the risk of mortality in critically ill children. IAP and PRISM scores may help identify children likely to develop ACS.

An Abdominal Aortic Rupture Due to Seatbelt Blunt Injury: Report of a Case

A 66-year-old man, who was a passenger in a car involved in a low-speed head-on motor vehicle accident, was rushed to our hospital. His abdomen was tender and distended. An enhanced computed tomography scan showed a massive retroperitoneal hematoma, and its three-dimensional imaging revealed an active leak of the contrast medium from the aortic bifurcation. He went into shock, and was immediately transferred to the operating theater. Through a median laparotomy, a ruptured site measuring 5 mm in diameter was found at the aortic bifurcation and it was closed with sutures under a proximal aortic control. The other organs showed no evidence of injury. Because of the remarkable edema of the bowel, mesentery, and retroperitoneum, the abdomen was temporarily closed with a mesh sheet to prevent the occurrence of abdominal compartment syndrome. A delayed closure was then successfully performed 4 days later, and he was discharged with no residual sequelae 17 days after the initial operation.