Table Of Contents
Abdominal Compartment Syndrome
Abdominal compartment syndrome is increased intra-abdominal pressure (intra-abdominal hypertension) due to interstitial oedema (third spacing) leading to vascular compromise, ischemia and organ dysfunction. Abdominal compartment syndrome should be suspected in any patient who develops oliguria/anuria, tachypnoea and hypotension after receiving large-volume resuscitation or transfusion. Diagnosis can be confirmed by measuring bladder pressure, which indirectly reflects intra-abdominal pressure.
Pathophysiology of abdominal compartment syndrome
| System | Pathophysiology |
|---|---|
| Cardiovascular | Impaired venous return → reduced cardiac output → tachycardia, hypotension and shock |
| Respiratory | High airway pressure, tachypnoea, low tidal volume → hypoxia and hypercarbia |
| CNS | Reduced jugular venous drainage → raised ICP and worsening cerebral oedema |
| Renal | Compression of renal vein and parenchyma → reduced renal blood flow and GFR → oliguria, anuria, and acute kidney injury |
| Gastrointestinal | Bowel oedema → reduced blood flow to the bowel → mesenteric ischemia, necrosis and perforation of bowel |
- Cause of abdominal compartment syndrome in the setting of trauma
- Massive fluid resuscitation (Crystalloids, pRBCs) causing visceral edema
- This effect is worsened due to cellular and tissue injury, especially in the setting of shock
- Hemoperitoneum, retroperitoneal hematoma and bowel distention can also exacerbate the condition
- Signs and symptoms
- Increased abdominal girth
- Shortness of breath
- Syncope
- Hypotension
- Decreased urinary output
- Intra-op or Post-op findings
- Intraoperatively Difficult to close the incision site over abdominal contents; Requires temporary closure
- Post-operatively: Symptoms typically begin POD2
- Investigations
- Urinary bladder pressure: requires a partially full bladder and a non-straining patients (relaxed or paralyzed)
- ≥ 25 mmHg (34 cm H2O) = suggests intra-abdominal hypertension
- ≥ 30 mmHg (41 cm H2O) = confirms the diagnosis of abdominal compartment syndrome
- Metabolic panel and ABGs: to assess the severity of renal failure and metabolic acidosis
- CT scan
- Urinary bladder pressure: requires a partially full bladder and a non-straining patients (relaxed or paralyzed)
- Treatment
- Decompressive laparotomy and temporary abdominal closure
- Diuretics to encourage reduction of intra-abdominal pressure once resuscitation is complete and euvolaemia is attained
- Dobutamine to increase flow to abdominal viscera
- Paracentesis
- Complications
- Renal failure (may require dialysis)
- Respiratory failure
- Bowel ischemia
- Increased ICP
- Reperfusion syndrome: Add mannitol and NaCO3 to IV fluids to reduce likelihood or severity
