Treatment Of Abdominal Compartment Syndrome Research Articles

Outcome of Laparostomy as a Treatment Measure for Abdominal Compartment Syndrome: A Retrospective Study

Introduction Abdominal compartment syndrome is a life-threatening condition that affects critically ill patients. When pressures inside a fixed cavity of the body increases, ischemia, muscle injury, and organ failure can result. Aim To assess the benefits and outcomes of laparostomy for abdominal compartment syndrome. Methods This retrospective study included patients who underwent a laparostomy procedure as a treatment measure for abdominal compartment syndrome, secondary to different etiologies such as sepsis and major abdominal visceral trauma. Results Although there are a few complications such as incisional hernia in the future following a laparostomy, the mortality rate following the procedure is less than < 10%, thus ensuring a good prognosis for patients who present with acute surgical emergencies. It could also be further noted that an early closure by 7 to 14 days had definite beneficial outcomes as compared with delayed closure of more than 14 days. It prevented most long-term complications such as entero-atmospheric fistula formation or granuloma formation, the outcomes of which were further aided by the use of a transparent custom-made polypropylene mesh. Conclusion Laparostomy is the gold standard treatment for abdominal compartment syndrome. The use of a custom-made polypropylene mesh has proven to have the least complications in the follow-up period. Incisional hernias are the most common complications documented, followed by entero-atmospheric fistula.

Vacuum-assisted laparostomy in severe abdominal trauma and urgent abdominal pathology with compartment syndrome, peritonitis and sepsis: Comparison with other options for multistage surgical treatment (systematic review and meta-analysis)

Background. The concept of multistage surgical treatment of patients has been established in surgery rather recently and therefore the discussions on the expediency of using a particular surgical technique in a specific situation still continue. Vacuum-assisted laparostomy is being widely implemented into clinical practice for the treatment of abdominal compartment syndrome, severe peritonitis and abdominal trauma, but the indications and advantages of this method are not clearly defined yet.The aim of the study. To conduct a systematic review and meta-analysis on the comparison of the effectiveness of vacuum-assisted laparostomy with various variants of relaparotomy and laparostomy without negative pressure therapy in the treatment of patients with urgent abdominal pathology and abdominal trauma complicated by widespread peritonitis, sepsis or compartment syndrome.Material and methods. A systematic literature search was conducted in accordance with the recommendations of “Preferred Reporting Items for Systematic Reviews and Meta-Analyses”. We carried out the analysis of non-randomized (since January 2007 until August 6, 2022) and randomized (without time limits for the start of the study and until August 6, 2022) studies from the electronic databases eLibrary, PubMed, Cochrane Library, Science Direct, Google Scholar Search, Mendeley.Results. Vacuum-assisted laparostomy causes statistically significant shortening of the time of treatment of patients in the ICU and in hospital and a decrease in postoperative mortality compared to other variants of laparostomy without vacuum assistance.Conclusion. To obtain data of a higher level of evidence and higher grade of recommendations, it is necessary to further conduct systematic reviews and meta-analyses based on randomized clinical studies.

Awareness and diagnosis for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in neonatal (NICU) and pediatric intensive care units (PICU) – a follow-up multicenter survey

BackgroundConstantly elevated intra-abdominal pressure (IAH) can lead to abdominal compartment syndrome (ACS), which is associated with organ dysfunction and even multiorgan failure. Our 2010 survey revealed an inconsistent acceptance of definitions and guidelines among pediatric intensivists regarding the diagnosis and treatment of IAH and ACS in Germany. This is the first survey to assess the impact of the updated guidelines on neonatal/pediatric intensive care units (NICU/PICU) in German-speaking countries after WSACS published those in 2013.MethodsWe conducted a follow-up survey and sent 473 questionnaires to all 328 German-speaking pediatric hospitals. We compared our findings regarding awareness, diagnostics and therapy of IAH and ACS with the results of our 2010 survey.ResultsThe response rate was 48% (n = 156). The majority of respondents was from Germany (86%) and working in PICUs with mostly neonatal patients (53%).The number of participants who stated that IAH and ACS play a role in their clinical practice rose from 44% in 2010 to 56% in 2016. Similar to the 2010 investigations, only a few neonatal/pediatric intensivists knew the correct WSACS definition of an IAH (4% vs 6%). Different from the previous study, the number of participants who correctly defined an ACS increased from 18 to 58% (p < 0,001). The number of respondents measuring intra-abdominal pressure (IAP) increased from 20 to 43% (p < 0,001). Decompressive laparotomies (DLs) were performed more frequently than in 2010 (36% vs. 19%, p < 0,001), and the reported survival rate was higher when a DL was used (85% ± 17% vs. 40 ± 34%).ConclusionsOur follow-up survey of neonatal/pediatric intensivists showed an improvement in the awareness and knowledge of valid definitions of ACS. Moreover, there has been an increase in the number of physicians measuring IAP in patients. However, a significant number has still never diagnosed IAH/ACS, and more than half of the respondents have never measured IAP. This reinforces the suspicion that IAH and ACS are only slowly coming into the focus of neonatal/pediatric intensivists in German-speaking pediatric hospitals. The goal should be to raise awareness of IAH and ACS through education and training and to establish diagnostic algorithms, especially for pediatric patients.The increased survival rate after conducting a prompt DL consolidates the impression that the probability of survival can be increased by timely surgical decompression in the case of full-blown ACS.

Gas detection in the portal vein after aortobifemoral bypass: a case report

We present a case report of early surgical treatment of abdominal compartment syndrome after aortobifemoral bypass. A 73-year-old man was admitted to the I.I. Mechnikov North-Western State Medical University with critical lower limb ischemia. Aortobifemoral bypass with a synthetic prosthesis was performed via laparotomy. The postoperative period was complicated by the dynamic bowel obstruction. The patient's condition worsened (hypovolemic and septic shock, respiratory failure due to severe pneumonia). Initial tactics was conservative. Signs of bowel ischemia (pneumatosis of the intestinal wall, gas in the portal vein) were identified using “point of care” ultrasound, which led to a change in the treatment tactics. On the same day, decompression relaparotomy was performed and the intestinal decompression tube was inserted. The postoperative period proceeded with positive dynamics: early extubation with acceptable parameters of gas exchange, minimal dosages of vasopressor support. Bowel function improved and stool appeared on the 2nd day after surgery.Gas in the portal vein is an ultrasound phenomenon, which in 70 % of cases suggests necrosis of the intestinal wall. The detection of such a symptom in patients after the abdominal aorta surgery may indicate bowel ischemia, since mesenteric circulation disorders primarily develop in the inferior mesenteric artery. This condition requires urgent surgical intervention, but its differential diagnosis with postoperative paralytic ileus is not always possible, especially in the early stages. We demonstrate a case of early gas detection in the portal vein and the emergency intervention that allowed preventing irreversible ischemic damage of the bowel. “Point of care” ultrasound can help suspect this condition and determine the indications for early surgical intervention, which can positively influence the outcome. Received 19 April 2022. Revised 29 May 2022. Accepted 1 June 2022. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authors: The authors contributed equally to this article.

Abdominal Compartment Syndrome in Acute Pancreatitis: A Narrative Review.

Abdominal compartment syndrome (ACS) represents a severe complication of acute pancreatitis (AP), resulting from an acute and sustained increase in abdominal pressure >20 mmHg, in association with new organ dysfunction. The harmful effect of high intra-abdominal pressure on regional and global perfusion results in significant multiple organ failure and is associated with increased morbidity and mortality. There are several deleterious consequences of elevated intra-abdominal pressure on end-organ function, including respiratory, cardiovascular, gastrointestinal, neurologic, and renal effects. It is estimated that about 15% of patients with severe AP develop intra-abdominal hypertension or ACS, with a mortality rate around 50%. The treatment of abdominal compartment syndrome in acute pancreatitis begins with medical intervention and percutaneous drainage, where possible. Abdominal compartment syndrome unresponsive to conservatory treatment requires immediate surgical decompression, along with vacuum-assisted closure therapy techniques, followed by early abdominal fascia closure.

Physicians' Knowledge of Abdominal Compartment Syndrome and Intra-Abdominal Hypertension in Saudi Arabia: An Online Cross-Sectional Survey Study.

To determine physicians' knowledge of abdominal compartment syndrome and intra-abdominal hypertension in Saudi Arabia. A cross-sectional online survey study was conducted on physicians in Saudi Arabia between March and August 2022. A previously developed questionnaire was adapted and used in this study. The survey instrument investigated the knowledge and management of intra-abdominal hypertension and abdominal compartment syndrome among physicians. Logistic regression was used to identify predictors of being knowledgeable about abdominal compartment syndrome and intra-abdominal hypertension. A total of 266 physicians participated in this study. Around one-fifth (21.8%) the study participants were ICU physicians and 25.0% reported that they practice internal medicine. Intra-abdominal hypertension (IAH) and the impact of increased intra-abdominal pressure (IAP) on organ function were terms that the majority of research participants (70.3%) reportedthey were familiar with. A similar percentage (73.7%) reported that they are familiar with abdominal compartment syndrome (ACS). Around 43.0% of the study participants reported that they do not know how to measure IAP. The most frequently reported (13.5%) intervention in the treatment of IAH and ACS was the use of inotropes or vasopressors. The study participants showed a weak level of knowledge of ACS and IAH with a median score of 3.00 (IQR: 5.00-2.00), which represents 27.3% of the maximum attainable score. Physicians working at hospitals with 20-50 ICU beds were 41.0% (odds ratio: 0.59 (CI: 0.37-0.96)) less likely to be knowledgeable about intra-abdominal hypertension and abdominal compartment syndrome (p≤0.05). Physicians demonstrated a low level of IAP and ACS knowledge. To increase the safety of medical practices and enhance clinical outcomes for patients, awareness should be raised about the proper diagnosis and managementof IAP and ACS. Future research should focus on developing effective educational strategies to improve physicians' understanding of IAP and ACS.

Nonsurgical treatment of abdominal compartment syndrome in a patient following living donor liver transplantation: a case report

Sarnai Erdene, Otgonbayar Setevdorj, Bat-Ireedui Badarch, Batsaikhan Batsuuri, Ganzorig Batjargal, Batsaikhan Bat-Erdene, Undarmaa Zandanbazar, Erdene Sandag, Sergelen Orgoi. Korean J Transplant 2022;36:366. https://doi.org/10.4285/ATW2022.F-5068

S1894 A Case of Severe Acute Alcoholic Pancreatitis Complicated With Abdominal Compartment Syndrome

Introduction: Abdominal compartment syndrome (ACS) is a sustained intra-abdominal pressure (IAP) above 20mmHg with associated new-onset organ dysfunction. Even though it is rarely seen in clinical practice, up to 15% of patients with severe acute pancreatitis (SAP) develop ACS and have a mortality rate of up to 49%. Given that delayed treatment of ACS is associated with high mortality and adverse outcome, a higher clinical suspicion is needed to aid diagnosis. We present a case of severe pancreatitis complicated with ACS. Case Description/Methods: A 29-year-old man with a history of alcohol abuse presented with five days of severe abdominal pain. He was diagnosed with SAP. About 8 hours into admission to the ICU and resuscitation, he began having worsening work of breathing and persistent severe abdominal pain despite being on adequate opioid analgesic. Physical examination revealed tachycardia, diffuse peritoneal signs, guarding, and shock. Repeat labs revealed worsening leukocytosis, thrombocytopenia, hyperkalemia, hypocalcemia, lactic acidosis, and elevated creatinine kinase. There was also evidence of renal failure. An edematous pancreas with some peripancreatic fluid collection was evident on the CT abdomen (Figure). The abdominal x-ray was unremarkable. Indirect intra-abdominal pressure (IAP) by intravesical catheter pressure measurement was 35mmHg. He commenced medical management with neuromuscular paralysis and mechanical ventilatory support. A repeat IAP was 24mmHg. He then got surgical decompression by full-thickness midline laparotomy with wound vac placement which further reduced the IAP to 10mmHg. He received serial dialysis, correction of abnormal electrolytes, and serial transfusion with blood products as required. He remained critically ill on a mechanical ventilator and vasopressors, with a poor prognosis at the time of this writing. Discussion: The pathophysiology of elevated IAP in SAP is multifactorial. These include retroperitoneal inflammation, ascites, acute peripancreatic fluid collections, visceral edema, and aggressive fluid resuscitation. We believe some of the above listed had ensued in our patient for days before he presented to the hospital. Physical examination is inaccurate in diagnosing ACS. The first-line treatment is medical paralysis followed by surgical decompression if ineffective. We are writing this case to recommend early serial IAP measurements in patients with SAP.Figure 1.: CT abdomen showing edematous pancreas with some peripancreatic fluid collection.

Open abdomen during extracorporeal membrane oxygenation is a safe and effective treatment for abdominal compartment syndrome

Background/PurposeDecompressive laparotomy and open abdomen for abdominal compartment syndrome have been historically avoided during Extracorporeal Membrane Oxygenation (ECMO) due to seemingly elevated risks of bleeding and infection. Our goal was to evaluate a cohort of pediatric respiratory ECMO patients who underwent decompressive laparotomy with open abdomen at a single institution and to compare these patients to ECMO patients without open abdomen. MethodsWe reviewed all pediatric respiratory ECMO (30 days-18 years) patients treated with decompressive laparotomy with open abdomen at Riley Hospital for Children (1/2000–12/2019) and compared these patients to concurrent respiratory ECMO patients with closed abdomen. We excluded patients with surgical cardiac disease. We assessed demographics, ECMO data, and outcomes and defined significance as p = 0.05. Results6 of 81 ECMO patients were treated with decompressive laparotomy and open abdomen. Open and closed abdomen groups had similar age (p = 0.223) and weight (0.286) at cannulation, but the open abdomen group had a higher reliance on vasoactive medications (Vasoactive Inotropic Score, p = 0.040). Open abdomen group survival was similar to closed abdomen patients (66.7%, vs 62.7%, p = 1). Open abdomen patients had lower incidence of ECMO complications (33.3% vs 83.6%, p = 0.014), but the groups had similar bleeding complications (p = 0.412) and PRBC transfusion volume (p = 0.941). Conclusion/ImpactPediatric ECMO patients with open abdomen after decompressive laparotomy had similar survival, blood products administered, and complications as those with a closed abdomen. An open abdomen is not a contra-indication to ECMO support in pediatric respiratory patients and should be considered in select patients.

Профилактика и лечение абдоминального компартмент-синдрома у больных с тяжелой термической травмой

Внутрибрюшная гипертензия и абдоминальный компартмент-синдром тесно связаны с заболеваемостью и смертностью среди критически больных. Несмотря на достаточно большое количество специальных публикаций, посвященных данной проблеме, очень мало внимания уделяется абдоминальному компартмент-синдрому у больных с тяжелой термической травмой. В ряде исследований показано, что тяжелые ожоги являются фактором риска развития внутрибрюшной гипертензии. Большие объемы инфузионной терапии, используемые при лечении тяжелой ожоговой травмы, дополнительно предрасполагают пациентов к увеличению внутрибрюшного давления. Частота развития внутрибрюшной гипертензии у больных с тяжелой термической травмой составляет, по данным разных авторов, 57,8–82,6 %. После возникновения абдоминального компартмент-синдрома и связанной с ним полиорганной дисфункции летальность при обширных ожогах очень высока. Цель данной работы — проанализировать проблему развития абдоминальной гипертензии и абдоминального компартмент-синдрома у ожоговых больных, а также сделать выводы о профилактике данного состояния и улучшении результатов лечения пострадавших с тяжелой термической травмой.

Occurrence and Risk Factors of Infected Pancreatic Necrosis in Intensive Care Unit–Treated Patients with Necrotizing Severe Acute Pancreatitis

BackgroundIn patients with severe acute pancreatitis (SAP), infected pancreatic necrosis (IPN) is associated with a worsened outcome. We studied risk factors and consequences of IPN in patients with necrotizing SAP. MethodsThe study consisted of a retrospective cohort of 163 consecutive patients treated for necrotizing SAP at a university hospital intensive care unit (ICU) between 2010 and 2018. ResultsAll patients had experienced at least one persistent organ failure and approximately 60% had multiple organ failure within the first 24 h from admission to the ICU. Forty-seven (28.8%) patients had IPN within 90 days. Independent risk factors for IPN were more extensive anatomical spread of necrotic collections (unilateral paracolic or retromesenteric (OR 5.7, 95% CI 1.5–21.1) and widespread (OR 21.8, 95% CI 6.1–77.8)) compared to local collections around the pancreas, postinterventional pancreatitis (OR 13.5, 95% CI 2.4–76.5), preceding bacteremia (OR 4.8, 95% CI 1.3–17.6), and preceding open abdomen treatment for abdominal compartment syndrome (OR 3.6, 95% CI 1.4–9.3). Patients with IPN had longer ICU and overall hospital lengths of stay, higher risk for necrosectomy, and higher readmission rate to ICU. ConclusionsWide anatomical spread of necrotic collections, postinterventional etiology, preceding bacteremia, and preceding open abdomen treatment were identified as independent risk factors for IPN.

Management of abdominal compartment syndrome in acute pancreatitis.

Abdominal compartment syndrome (ACS), defined by the presence of increased intra-abdominal pressure>20mmHg in association with failure of at least one organ system, is a common and feared complication that may occur in the early phase of severe acute pancreatitis (AP). This complication can lead to patient death in the very short term. The goal of this review is to provide the surgeon and intensivist with objective information to help them in their decision-making. In the early phase of severe AP, it is essential to monitor intra-vesical pressure (iVP) to allow early diagnosis of intra-abdominal hypertension or ACS. The treatment of ACS is both medical and surgical requiring close collaboration between the surgical and resuscitation teams. Medical treatment includes vascular volume repletion, prokinetic agents, effective curarization and percutaneous drainage of large-volume ascites. If uncontrolled respiratory or cardiac failure develops or if maximum medical treatment fails, most teams favor performing an emergency xipho-pubic decompression laparotomy with laparostomy. This procedure follows the principles of abbreviated laparotomy as described for abdominal trauma.

Open Abdomen during Extracorporeal Membrane Oxygenation is a Safe and Effective Treatment for Abdominal Compartment Syndrome

Background/Purpose &#x0D; Historically, decompressive laparotomy and open abdomen for abdominal compartment syndrome has contraindicated Extracorporeal Membrane Oxygenation (ECMO) due to seemingly high risk of bleeding and infection. The literature shows few examples of this treatment, and the existing studies are inconclusive. The purpose of this study was to review the series at Riley Hospital for Children and evaluate the effectiveness of ECMO treatment for patients undergoing decompressive laparotomy with open abdomen to recommend future care guidelines. &#x0D; Methods &#x0D; We reviewed all pediatric (30 days to 18 years) patients treated with ECMO concurrently with decompressive laparotomy and open abdomen at Riley Hospital for Children from 2000-2019. We compared these patients with non-surgical pediatric patients supported with ECMO for respiratory failure at Riley Hospital for Children during the same period. Demographics, ECMO data, and outcomes were assessed. We performed t-test, ROC, and chi-square analyses. We defined significance as p=0.05. &#x0D; Results &#x0D; 5 of 82 pediatric respiratory ECMO patients were treated with decompressive laparotomy and open abdomen. Survival among the surgical group was 60%, compared to 57% in the non-surgical group (p=0.9). Surgical patients had a similar incidence of bleeding complications (40%) compared to non-surgical patients (55.8%), p=0.486. Surgical patients had a significantly higher VIS (3126 vs 19.2, p=0.004), PaO2/FiO2 ratio (279.0 vs 72.9, p=0.031), and pump flow rate at 24hrs (112mL/kg/min vs 88.1mL/kg/min, p=0.045) than non-surgical patients, while receiving a similar volume of PRBCs (p=0.581) and requiring ECMO treatment for a similar amount of time (p=0.511). &#x0D; Conclusion/Potential Impact &#x0D; ECMO support in patients with decompressive laparotomy and open abdomen was associated with similar survival and bleeding complications compared to non-surgical ECMO patients. ECMO should be offered to or continued in eligible patients with abdominal catastrophe, as it is effective in supporting organ function while not significantly increasing the risk for complications.

Management of open complicated abdomen

Critically-ill patients may have their abdomens opened as a result of primary pathology (damage-control laparotomy in trauma, soiled peritoneum from perforated hollow viscus, necrotizing pancreatitis), or as treatment for abdominal compartment syndrome (defined as new organ dysfunction associated with intra-abdominal hypertension).The incidence and implications of intra-abdominal hypertension and abdominal compartment syndrome (ACS) in particular, are currently debated.Intra-abdominal hypertension (IAH) is defined as a sustained intra-abdominal pressure ≥ 12 mmHg. Grading is possible; Grade I = IAP 12 to 15 mmHg, Grade II = IAP 16 to 20 mmHg, Grade III = IAP 21 to 25 mmHg, Grade IV = IAP >25 mmHg. Management principles include reduction of intra-abdominal gas (NGT and flatus) and intra-abdominal fluid (the latter may be interstitial or intra-peritoneal), and ensuring the abdominal wall is as compliant as possible. Definitive management is to open the abdomen however, the benefits and use of the open abdomen (OA) approach are unclear. The rates of OA appear to be reducing worldwide.The reduction in the incidence of ACS requiring laparostomy may be related to global changes in resuscitation targets1, rather than changes in surgical techniques. In particular, the notion of ‘fluid de-resuscitation’ may be implicated in improved outcomes.The decision to leave the abdomen open after emergent laparotomy seems to be dependent on the surgical specialty of the operating surgeon, and is a common approach applied in victims of blunt abdominal trauma2.Complications of the open abdomen relate mainly to nutritional status and long-term abdominal complications. The most feared abdominal complication relates to the inability to close the abdominal fascia, with associated increases in mortality, fistula formation, and ventral hernias.Current critical care focus is on the prevention of the open abdomen. For intra-abdominal hypertension and acute compartment syndrome, medical management aimed at reduction of abdominal wall pressure and evacuation of intra-abdominal contents (including fluid) are cornerstone strategies. The use of neuromuscular blocking agents is controversial; short-term benefit may be outweighed by long-term complications.For the de novo open abdomen, current research suggests a possible role for more aggressive early closure (primary or before day 5, latest day 8). Further research is required to confirm whether primary closure is safe. Temporary closure techniques using a combination of negative abdominal wall pressure in combination with partial mesh reduction seems to be helpful in increasing successful abdominal closure rates3.Aggressive infection control and nutritional support after 72 hours is key. Common to both scenarios is the need for careful, judicious fluid management; organ perfusion must be optimized, but not at the expense of massive bowel and abdominal wall edema. The latter complicates healing and closure4.A final question is whether extubating patients with an open abdomen is safe and feasible. The literature provides a resounding yes to this issue5.

Successful treatment of abdominal compartment syndrome with chemotherapy in a patient with a newly diagnosed Burkitt lymphoma

Mortality of patients treated on the intensive care unit suffering from cancer is high, especially when admitted with an unknown malignancy. Still, anti-tumor therapy in critically ill patients requiring mechanical ventilation is a clinical challenge. Over the last years, successful chemotherapy has been reported, even in critically ill patients with infections and organ failure. In this report, we present a 42-year old male patient who later was been diagnosed for a highly-malignant lymphoma (Burkitt) developed an abdominal compartment syndrome due to ileus, ascites and progressive intestinal tumor manifestation. During the course, he required mechanical ventilation and developed several organ failures including need for renal replacement therapy. After laparotomy the abdomen was left open and managed by a vacuum dressing. The patient received systemic chemotherapy and broad anti-infective treatment in presence of markedly elevated markers of inflammation. Fortunately, he was successfully weaned from vasopressor and respiratory support. By obtaining negative fluid balances closure of the abdomen succeeded 18 days after laparotomy. The patient was transferred to the normal ward without organ dysfunction on day 27 and discharged home after a second cycle of chemotherapy. In conclusion, aggressive treatment using chemotherapy in critically ill patients with initially unkown malignancy may be successful.

Successful surgical treatment of abdominal compartment syndrome in patient with pancreatic necrosis

Case report of patient with severe autonomous advanced pancreatic necrosis followed by compartment syndrome is presented. Augmentation of intra-abdominal pressure from 18 to 30 mm Hgwas accompanied by aggravation of respiratory, renal and intestinal insufficiency. Urgent video-assisted fasciotomy was applied with dissection of linea alba while peritoneum was preserved. Postoperative period was characterized by reduced intra-abdominal pressure followed by its normalization after 24 hours. Favorable clinical effect was achieved. Subsequent medication was able to avoid surgery and minimally invasive procedures. Patient was discharged after 28 days.

Effect of decompressive laparotomy on organ function in patients with abdominal compartment syndrome: a systematic review and meta-analysis

BackgroundDecompressive laparotomy has been advised as potential treatment for abdominal compartment syndrome (ACS) when medical management fails; yet, the effect on parameters of organ function differs markedly in the published literature. In this study, we sought to investigate the effect of decompressive laparotomy on intra-abdominal pressure and organ function in critically ill adult and pediatric patients with ACS, specifically focusing on hemodynamic, respiratory, and kidney function and outcome.MethodsA systematic review and meta-analysis of the literature was performed. Articles reporting data on intra-abdominal pressure (IAP), hemodynamic (mean arterial pressures [MAP], central venous pressure [CVP], cardiac index [CI], heart rate [HR], systemic vascular resistance index [SVRI] and/or pulmonary capillary wedge pressure [PCWP]), respiratory (positive end-expiratory pressure [PEEP], peak inspiratory pressure [PIP] and/or ratio of partial pressure arterial oxygen and fraction of inspired oxygen [P/F ratio]), and/or urinary output (UO) following decompressive laparotomy were analyzed.ResultsA total of 15 articles were included; 3 included children only (aged 18 years or younger). Of the 286 patients who were included, 49.7% had primary ACS. The baseline mean IAP in adults decreased with an average of 18.2 ± 6.5 mmHg following decompression, from 31.7 ± 6.4 mmHg to 13.5 ± 3.0 mmHg. There was a decrease in HR (12.2 ± 9.5 beats/min; p = 0.04), CVP (4.6 ± 2.3 mmHg; p = 0.022), PCWP (5.8 ± 2.3 mmHg; p = 0.029), and PIP (10.1 ± 3.9 cmH2O; p < 0.001) and a mean increase in P/F ratio (70.4 ± 49.4; p < 0.001) and UO (95.3 ± 105.3 ml/h; p < 0.001). In children, there was a significant increase in MAP (20.0 ± 2.3 mmHg; p = 0.006), P/F ratio (238.2; p < 0.001), and UO (2.88 ± 0.64 ml/kg/h; p < 0.001) and a decrease in CVP (7 mmHg; p = 0.016) and PIP (9.9 cmH2O; p = 0.002). The overall mortality rate was 49.7% in adults and 60.8% in children following decompressive laparotomy.ConclusionsDecompressive laparotomy resulted in a significantly lower IAP and had beneficial effects on hemodynamic, respiratory, and renal parameters. Mortality after decompressive laparotomy remains high in both adults and children.

Open Surgical Decompression Is Useful for the Prevention and Treatment of Abdominal Compartment Syndrome after the Repair of Ruptured Abdominal Aortic and Iliac Artery Aneurysm.

Objective: This study was performed to determine whether open surgical decompression (OSD) decreased the mortality associated with abdominal compartment syndrome (ACS) following open repair (OR) of ruptured abdominal aortic aneurysm and iliac aneurysm (rAAA), and to investigate the risk factors associated with OSD.Material and Methods: Total 113 consecutive patients with rAAA underwent OR in our institution. Ninety patients underwent primary abdominal closure; however, three of them developed ACS and required OSD. Prophylactic OSD was performed at the initial OR in 23 patients.Results: The in-hospital mortality rate was higher in those who underwent OSD than in those who did not undergo OSD [27.0% (7/26) vs. 6.9% (6/87), respectively; p=0.01]. However, no ACS-related death occurred in the OSD group. Multivariate analyses revealed that a preoperative/intraoperative base excess (BE)<−11 [p=0.045; odds ratio (OR), 3.33; 95% confidence interval (CI), 1.021–10.850], performance of left thoracotomy (p=0.038; OR, 5.17; 95%CI, 1.098–24.357), and intraoperative blood transfusion >1,800 mL (p=0.012; OR, 4.30; 95%CI, 1.386–13.322) were associated with OSD.Conclusion: The prevalence and mortality rates of ACS were low at our institution. OSD is considered to be useful for the prevention and treatment of ACS after repair of rAAA. OSD should be considered in patients with the above-mentioned factors.

Modern methods for diagnosis and treatment of abdominal compartment syndrome

The aim — to study the effect of intraabdominal hypertension on the treatment outcome in patients with acute abdominal pathology and analyze modern methods for the treatment of abdominal compartment syndrome.Materials and methods. The work is based on the analysis of the treatment results in 33 patients urgently operated during the period from 2014 to 2016. All patients underwent preoperative and postoperative measurements of intra­abdominal pressure by indirect measurement of the bladder pressure using a closed system of Unometer Abdo­Pressure. In case when the pressure increased for more than 35 mm Hg, decompression laparotomy was performed.Results and discussion. In the postoperative period, an increase in intraabdominal pressure was diagnosed in 25 (75.8 %) patients. I degree of intraabdominal pressure was found in 7 (28 %) patients, II degree in 9 (36 %) patients, III degree in 5 (20 %) patients, IV degree of intraabdominal hypertension was noted in 4 (16 %) patients. At I — II degrees of intraabdominal pressure no lethal cases were observed. At grade III — IV, the disease ended in a lethal outcome in 5 (20 %) patients. The application of flat vacuum drains in the laparotomic wound allowed to stabilize the condition for two programmed abdominal sanitizations in 6 (24 %) patients, for three — in 3 (12 %) patients, which allowed to close the laparotomic wound.Conclusions. The incidence of intraperitoneal hypertension in patients operated on acute abdominal pathology was 25 (75.8 %) patients, and in 9 (36 %) patients, there was a need for decompression relaparotomy. The application of nasointestinal decompression, vacuum assisted laparotomy in the complex treatment of abdominal compartment syndrome allowed to stabilize the abdominal cavity, laparotomy wound for 7.0 ± 1.2 days and reduce mortality down to 20 %.

Les syndromes aortiques aigus

Acute aortic syndromes include aortic dissections, intramural hematomas, penetrating ulcers, ruptured or contained ruptured aortic aneurysms. In presence of acute thoracic or dorsal pain, elevated D-Dimers and if acute coronary artery syndrome has been ruled out, additional imaging should be performed to detect acute aortic pathologies. Acute type A dissections involve the ascending aorta. Emergent open repair is the preferred treatment. Acute type B dissections involve the thoracic descending aorta. Endovascular treatment using thoracic stent grafts is indicated in complicated cases (malperfusion, rupture, uncontrolled hypertension) or in cases where risk factors of aortic degeneration are identified. Regarding ruptured abdominal aortic aneurysms, optimization techniques recently led to a reduced postoperative mortality. They include adequate treatment of abdominal compartment syndrome, use of aortic stent grafts, endovascular balloon occlusion and permissive hypotension. Symptomatic complex aneurysms encompass renal and visceral arteries. Nowadays, they can be treated in an urgent setting using new endovascular techniques, such as "off-the shelf" branched stent grafts, parallel techniques, home made or in situ fenestrations of standard stent grafts.