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Abdominal Compartment Syndrome
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Abdominal compartment syndrome remains a severe complication resulting from a sustained increase in intra-abdominal pressure causing significant morbidity and mortality. When managing patients at risk for developing IAH/ACS appropriate monitoring and measuring of IAP will lead to early intervention and better outcomes in patients with IAH/ACS.
The Open Abdomen
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
There are profound cardiovascular, respiratory and abdominal consequences of abdominal compartment syndrome. Raised intra-abdominal pressure splints the diaphragm, reducing functional lung capacity and compliance and raising airway pressures leading to hypercarbia and hypoxia.6 The raised intrathoracic and intra-abdominal pressures significantly reduce venous return via the superior and inferior vena cavae and coupled with increased afterload markedly decreases cardiac output; the neck veins will often appear full, erroneously suggesting hypervolaemia.7 Direct compression of the renal vasculature and decreased cardiac output contribute to reduced renal perfusion, consequent oliguria and the metabolic derangements of acute kidney injury, while splanchnic vascular compression leads to gut mucosal ischaemia and potentially increased gut translocation which may contribute to a significant systemic inflammatory response and sepsis.8 Ischaemia of the abdominal wall itself reduces compliance and contributes to difficulties in direct fascial closure,9 and abdominal compartment syndrome can also lead to a rise in intracranial pressure due to obstruction to cerebral venous outflow with a concomitant secondary brain injury.10 The mortality rate for abdominal compartment syndrome is up to 50% even if subsequently decompressed.11
Abdomen
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Abdominal compartment syndrome is organ dysfunction secondary to impaired organ perfusion because of increased abdominal pressure. The normal values of intra-abdominal pressure (IAP) are 5–7 mmHg, although morbidly obese patients and pregnant women can have pressures up to 10 mmHg.
Clinical spectrum, risk factors, management and outcome of patients with retroperitoneal hematoma: a retrospective analysis of 3-year experience
Published in Expert Review of Hematology, 2020
Kamal Kant Sahu, Ajay Kumar Mishra, Amos Lal, Susan V. George, Ahmad Daniyal Siddiqui
Hemorrhagic shock, rapid fall in hemoglobin and altered mentation secondary to hypoperfusion are expected sequelae if RPH is either massive or goes unnoticed. Cases with preexisting comorbidities like thrombocytopenia, platelet dysfunction, hemophilia, anticoagulation could be extremely devastating [38,39]. In addition to the above-mentioned complications, intra-abdominal compartment syndrome (ICS) or organ dysfunction secondary to mass effect are other extremely important complications that might require urgent surgical intervention [38]. In our study, we found that 14 cases had a mass effect (Figure 13). While in most cases, the mass effect was temporary and limited only to anatomical displacement, only 3 patients had functional compromise (2 with neuropathy and 1 hydroureteronephrosis requiring bilateral percutaneous nephrostomy tube placement). Daliakopoulos et reported a case series of 4 patients with RPH-related ICS [39]. All of them developed ICS secondary to heparin induced RPH following the insertion of ventricular assist devices. In that series, the average days of ICU stay were 64 days with 1 mortality. ICS can be at the extreme end of the spectrum of mass effect causing multiorgan dysfunction syndrome and hence awareness regarding this entity is of utmost importance. None of our patients in our study developed ICS.
Liver function assessment by indocyanine green plasma disappearance rate in patients with intra-abdominal hypertension after “non-hepatic” abdominal surgery
Published in Current Medical Research and Opinion, 2018
Normal IAP in adult is 0–5 mmHg, in typical ICU patients it is 5–7 mmHg, but after laparotomy it is 10–15 mmHg. Intra-abdominal hypertension can cause significant end-organ dysfunction or failure, and can lead to abdominal compartment syndrome (ACS), which is a life threatening condition23–27. ACS is defined as a sustained IAP >20 mmHg (with or without an abdominal perfusion pressure, APP <60 mmHg) that is associated with new organ dysfunction/failure. Often, APP is a therapeutic goal in patients with IAH, because there are individual differences of IAP values which trigger pathophysiological events. APP is the difference between mean arterial pressure and intra-abdominal pressure (APP = MAP − IAP), with the values of 50–60 mmHg being its therapeutic goal28–32.
The passage of fluid into the peritoneal cavity during hysteroscopy in pre-menopausal and post-menopausal patients
Published in Journal of Obstetrics and Gynaecology, 2018
Janka Palancsai Siftar, Monika Sobocan, Iztok Takac
This study can improve the understanding of the factors influencing the development of complications during HSC. Our findings show the increased rates of fluid passage and fluid speed into the peritoneal cavity in pre-menopausal patients. This highlights the need for caution when using increased volumes of fluid medium during an HSC in this patient group. Fluid absorbed during an HSC is absorbed mainly transmurally (through the myometrium) rather than transtubally. This is important with respect to fluid overload. Therefore, it is more imperative to reduce transmyometrial loss than transtubal loss, as the latter is relatively unimportant in this regard. It is not possible to draw any conclusion as to whether this increase is associated with a higher risk of abdominal compartment syndrome.