The Open Abdomen
Jeff Garner, Dominic Slade in 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
Critical Care of the Trauma Patient
Kenneth D Boffard in Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
The clinician should look for and manage these common causes: Hypovolaemia.Rhabdomyolysis.Abdominal compartment syndrome.Obstructive uropathy.Avoid nephrotoxic dyes where possible. There is evidence that CT contrast is unlikely to be harmful.38
Management of the Major Coagulopathy with Onset during Laparotomy
Stephen M Cohn, Ara J. Feinstein in 50 Landmark Papers every Trauma Surgeon Should Know, 2019
Now an abdominal compartment syndrome must be managed. This is exactly what surgeons faced in the early 1900s when correcting large omphaloceles (i.e., gaps greater than 5 cm) in newborns. If clearly too tight, the infant would first have tachycardia, followed by bradycardia, and then death. The significantly increased intra-abdominal pressure would have compressed the cava and other veins so as to prevent adequate return of blood to the heart from the abdomen and lower torso. Fascial closure would then immediately be abandoned and then a ventral hernia created with only skin approximation. In 6 weeks to 6 months, this midline hernia would be corrected.
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.
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.
Physiology of intra‐abdominal volume during pregnancy
Published in Journal of Obstetrics and Gynaecology, 2021
Aleksei Petrovich Petrenko, Camil Castelo-Branco, Dimitry Vasilevich Marshalov, Alexander Valerievich Kuligin, Yuliya Sergeevna Mysovskaya, Efim Munevich Shifman, Adam Muhamed Rasulovich Abdulaev
The study of intra-abdominal pressure (IAP) as a crucial factor of homeostasis has long attracted the attention of researchers. However, over the last 10 years scant attention has been paid to obstetrics problems related to intra-abdominal hypertension (IAH). A causal relationship between IAH and the development of adverse obstetric and perinatal outcomes has been suggested (Sawchuck and Wittmann 2014; Malbrain et al. 2015; Sun et al. 2015). Nevertheless, the role of IAH as a leading cause of systemic dysfunction during pregnancy remains unrecognised and underestimated. To improve this gap, the World Society for Abdominal Syndrome has promoted studies to understand the epidemiology, anatomy, and pathophysiology of IAH and abdominal compartment syndrome (ACS; Kirkpatrick et al. 2013), but again, the IAH question in obstetrics remains a poorly understood topic. Possible reasons include the complexity of the interpretation of this phenomenon during pregnancy, the anatomic and physiologic characteristics of the body of pregnant women and the high adaptive capabilities of the body to dynamic physiological processes. The study of abdominal pressure indicators, such as intra-abdominal volume (IAV) and compliance will help to a better understand the aetiology, pathophysiology, prognosis, and treatment strategies for pregnant women with IAH. This study was designed with the aim of assessing the dynamics of IAV in uncomplicated singleton pregnancies.
Related Knowledge Centers
- Aortic Rupture
- Abdomen
- Lung
- Circulatory System
- Multiple Organ Dysfunction Syndrome
- Sepsis
- Kidney
- Obstructive Shock
- Abdominal Trauma
- Reperfusion Injury