https://wikem.org/w/index.php?action=history&feed=atom&title=Abdominal_compartment_syndrome%2Fen 2026-04-17T18:16:07Z Revision history for this page on the wiki MediaWiki 1.38.2 https://wikem.org/w/index.php?title=Abdominal_compartment_syndrome/en&diff=378890&oldid=prev 2026-01-04T21:35:40Z

<p>Updating to match new version of source page</p> <p><b>New page</b></p><div>&lt;languages/&gt;<br /> <br /> ==Background==<br /> <br /> [[File:Scheme body cavities-en.png|thumb|Lateral view showing abdominopelvic cavity.]]<br /> *Organ dysfunction caused by intrabdominal hypertension <br /> *Increased intrabdominal pressure resulting in decreased organ perfusion, impaired hemodynamics<br /> <br /> <br /> ===Pathophysiology===<br /> <br /> *Abdominal perfusion pressure = MAP - intrabdominal pressure<br /> *Build up of fluid or blood within the peritoneum or retroperitoneum<br /> **And/or decrease in abdominal wall compliance<br /> *Increased pressure within cavity of fixed volume → hypoperfusion of abdominal organs<br /> **Also causes restriction of diaphragmatic excursion and impaired central venous return<br /> <br /> <br /> ===Causes===<br /> <br /> *Acute [[Special:MyLanguage/Pancreatitis|Pancreatitis]]<br /> *[[Special:MyLanguage/Ascites|Ascites]]<br /> *Diffuse [[Special:MyLanguage/peritonitis|peritonitis]]<br /> *Large volume [[Special:MyLanguage/IVF|fluid resuscitation]]<br /> *Reperfusion of [[Special:MyLanguage/ischemic bowel|ischemic bowel]]<br /> *[[Special:MyLanguage/Retroperitoneal hemorrhage|Retroperitoneal hemorrhage]]<br /> *[[Special:MyLanguage/Small bowel obstruction|Small bowel obstruction]]<br /> *[[Special:MyLanguage/Trauma|Trauma]]<br /> <br /> <br /> ==Clinical Features==<br /> <br /> *Most patients are critically ill and unable to communicate<br /> *Decreased [[Special:MyLanguage/hypotension|central venous return]]<br /> **Increased JVP<br /> **[[Special:MyLanguage/Increased ICP|Increased ICP]]<br /> **Decreased cardiac preload<br /> **Increased cardiac afterload<br /> *Increased intrathoracic pressure<br /> **Decreased lung compliance (will cause high peak pressures in vented patients)<br /> **Decreased functional residual capacity<br /> **Worsened [[Special:MyLanguage/hypoxia|V/Q mismatch]]<br /> *Oliguria, [[Special:MyLanguage/renal failure|renal failure]]<br /> *[[Special:MyLanguage/ischemic bowel|Bowel ischemia]]<br /> <br /> <br /> ==Differential Diagnosis==<br /> <br /> {{Abdominal trauma DDX}}<br /> <br /> <br /> ==Evaluation==<br /> <br /> [[File:PMC3267056 jkss-81-S1-g002.png|thumb|Abdominal compartment syndrome caused by bulimia post vomiting. CT shows dilated stomach with food and air pressed other visceral organs and major abdominal vessels.]]<br /> [[File:PMC4972924 gr2.png|thumb|A case of abdominal compartment syndrome derived from simple elongated sigmoid colon in an elderly man.. Abdominal CT scan of the patient pre-decompression (a) and post-decompression (b). The arrow shows the inferior vena cava, which was collapsed pre-decompression.]]<br /> <br /> ===Workup===<br /> <br /> ''Physical exam is neither sensitive nor specific''<br /> ;[https://emergencymedicinecases.com/em-quick-hits-jan2021/ Link to] steps on how to measure bladder pressure with arterial line and [https://www.youtube.com/watch?v=boknlf6cqXg video].<br /> *Obtain bladder pressure<br /> **Normal = &lt;12 mmHg<br /> **Intra-abdominal hypertension (IAH) = 12 - 20 mmHg<br /> **Concern for abdominal compartment syndrome = &gt;20 mmHg (also requires evidence of end-organ damage)<br /> <br /> <br /> ===Diagnosis===<br /> <br /> *Abdominal compartment syndrome = IAH &gt;20 mmHg PLUS end-organ damage<br /> *Abdominal perfusion pressure &lt;60 mmHg suggests abdominal hypoperfusion&lt;ref&gt;Al-Dorzi HM et al. Intra-abdominal pressure and abdominal perfusion pressure in cirrhotic patients with septic shock. Ann Intensive Care. 2012; 2(Suppl 1): S4.&lt;/ref&gt;<br /> *Note that IVC scanning for volume status is especially unreliable as collapse may not represent volume depletion in the context of high intra-abdominal pressures&lt;ref&gt;Bauman Z et al. Inferior vena cava collapsibility loses correlation with internal jugular vein collapsibility during increased thoracic or intra-abdominal pressure. J Ultrasound. 2015 Dec; 18(4): 343–348.&lt;/ref&gt;<br /> <br /> <br /> ==Management==<br /> <br /> <br /> ===Nonoperative===<br /> <br /> ''Often first line approach when no abdominal injury present&lt;ref&gt;Hunt, L., Frost, S. A., Hillman, K., Newton, P. J. and Davidson, P. M. (2014) ‘Management of intra-abdominal hypertension and abdominal compartment syndrome: a review’, Journal of Trauma Management &amp; Outcomes, 8(1).&lt;/ref&gt;''<br /> *Limit fluid resuscitation<br /> *[[Special:MyLanguage/Nasogastric tube|Nasogastric]] and bladder decompression<br /> *[[Special:MyLanguage/Electrolyte repletion|Electrolyte repletion]]<br /> *[[Special:MyLanguage/Antibiotics|Antibiotics]]<br /> *[[Special:MyLanguage/Pressors|Pressors]] with goal MAP 65<br /> *CRRT<br /> *Percutaneous fluid drainage (remove ascites if present)<br /> *Treat pain and adequately sedate<br /> *Reverse Trendelenburg<br /> *Consider [[Special:MyLanguage/metoclopramide|metoclopramide]]<br /> <br /> <br /> ===Operative===<br /> <br /> ''Definitive treatment''<br /> *Laparotomy provides decompression<br /> **High complication rate<br /> **No guidelines for timing of closure<br /> <br /> <br /> ==Disposition==<br /> <br /> *Admit<br /> <br /> <br /> ==See Also==<br /> <br /> *&quot;Traditional&quot; [[Special:MyLanguage/compartment syndrome|compartment syndrome]]<br /> <br /> <br /> ==External Links==<br /> <br /> <br /> ==References==<br /> <br /> &lt;references/&gt;<br /> <br /> [[Category:GI]]<br /> [[Category:Surgery]]<br /> [[Category:Critical Care]]</div>

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