Abdominal compartment syndrome: Difference between revisions
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==Background==
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==Background== <!--T:1-->
 
<!--T:2-->
[[File:Scheme body cavities-en.png|thumb|Lateral view showing abdominopelvic cavity.]]
[[File:Scheme body cavities-en.png|thumb|Lateral view showing abdominopelvic cavity.]]
*Organ dysfunction caused by intrabdominal hypertension  
*Organ dysfunction caused by intrabdominal hypertension  
*Increased intrabdominal pressure resulting in decreased organ perfusion, impaired hemodynamics
*Increased intrabdominal pressure resulting in decreased organ perfusion, impaired hemodynamics


===Pathophysiology===
 
===Pathophysiology=== <!--T:3-->
 
<!--T:4-->
*Abdominal perfusion pressure = MAP - intrabdominal pressure
*Abdominal perfusion pressure = MAP - intrabdominal pressure
*Build up of fluid or blood within the peritoneum or retroperitoneum
*Build up of fluid or blood within the peritoneum or retroperitoneum
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**Also causes restriction of diaphragmatic excursion and impaired central venous return
**Also causes restriction of diaphragmatic excursion and impaired central venous return


===Causes===
*Acute [[Pancreatitis]]
*[[Ascites]]
*Diffuse [[peritonitis]]
*Large volume [[IVF|fluid resuscitation]]
*Reperfusion of [[ischemic bowel]]
*[[Retroperitoneal hemorrhage]]
*[[Small bowel obstruction]]
*[[Trauma]]


==Clinical Features==
===Causes=== <!--T:5-->
 
<!--T:6-->
*Acute [[Special:MyLanguage/Pancreatitis|Pancreatitis]]
*[[Special:MyLanguage/Ascites|Ascites]]
*Diffuse [[Special:MyLanguage/peritonitis|peritonitis]]
*Large volume [[Special:MyLanguage/IVF|fluid resuscitation]]
*Reperfusion of [[Special:MyLanguage/ischemic bowel|ischemic bowel]]
*[[Special:MyLanguage/Retroperitoneal hemorrhage|Retroperitoneal hemorrhage]]
*[[Special:MyLanguage/Small bowel obstruction|Small bowel obstruction]]
*[[Special:MyLanguage/Trauma|Trauma]]
 
 
==Clinical Features== <!--T:7-->
 
<!--T:8-->
*Most patients are critically ill and unable to communicate
*Most patients are critically ill and unable to communicate
*Decreased [[hypotension|central venous return]]
*Decreased [[Special:MyLanguage/hypotension|central venous return]]
**Increased JVP
**Increased JVP
**[[Increased ICP]]
**[[Special:MyLanguage/Increased ICP|Increased ICP]]
**Decreased cardiac preload
**Decreased cardiac preload
**Increased cardiac afterload
**Increased cardiac afterload
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**Decreased lung compliance (will cause high peak pressures in vented patients)
**Decreased lung compliance (will cause high peak pressures in vented patients)
**Decreased functional residual capacity
**Decreased functional residual capacity
**Worsened [[hypoxia|V/Q mismatch]]
**Worsened [[Special:MyLanguage/hypoxia|V/Q mismatch]]
*Oliguria, [[renal failure]]
*Oliguria, [[Special:MyLanguage/renal failure|renal failure]]
*[[ischemic bowel|Bowel ischemia]]
*[[Special:MyLanguage/ischemic bowel|Bowel ischemia]]


==Differential Diagnosis==
 
==Differential Diagnosis== <!--T:9-->
 
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{{Abdominal trauma DDX}}
{{Abdominal trauma DDX}}
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==Evaluation==
==Evaluation== <!--T:10-->
 
<!--T:11-->
[[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.]]
[[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.]]
[[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.]]
[[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.]]
===Workup===
 
===Workup=== <!--T:12-->
 
<!--T:13-->
''Physical exam is neither sensitive nor specific''
''Physical exam is neither sensitive nor specific''
;[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].
;[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].
*Obtain bladder pressure
*Obtain bladder pressure
**Normal < 12 mmHg
**Normal = <12 mmHg
**Intra-abdominal hypertension (IAH) = 12 - 20 mmHg
**Intra-abdominal hypertension (IAH) = 12 - 20 mmHg
**Concern for abdominal compartment syndrome = >20 mmHg (also requires evidence of end-organ damage)


===Diagnosis===
 
**Abdominal compartment syndrome = IAH >20 mmHg PLUS end-organ damage
===Diagnosis=== <!--T:14-->
 
<!--T:15-->
*Abdominal compartment syndrome = IAH >20 mmHg PLUS end-organ damage
*Abdominal perfusion pressure <60 mmHg suggests abdominal hypoperfusion<ref>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.</ref>
*Abdominal perfusion pressure <60 mmHg suggests abdominal hypoperfusion<ref>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.</ref>
*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<ref>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.</ref>
*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<ref>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.</ref>


==Management==
 
===Nonoperative===
==Management== <!--T:16-->
 
 
===Nonoperative=== <!--T:17-->
 
<!--T:18-->
''Often first line approach when no abdominal injury present<ref>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 & Outcomes, 8(1).</ref>''
''Often first line approach when no abdominal injury present<ref>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 & Outcomes, 8(1).</ref>''
*Limit fluid resuscitation
*Limit fluid resuscitation
*[[Nasogastric tube|Nasogastric]] and bladder decompression
*[[Special:MyLanguage/Nasogastric tube|Nasogastric]] and bladder decompression
*[[Electrolyte repletion]]
*[[Special:MyLanguage/Electrolyte repletion|Electrolyte repletion]]
*[[Antibiotics]]
*[[Special:MyLanguage/Antibiotics|Antibiotics]]
*[[Pressors]] with goal MAP 65
*[[Special:MyLanguage/Pressors|Pressors]] with goal MAP 65
*CRRT
*CRRT
*Percutaneous fluid drainage (remove ascites if present)
*Percutaneous fluid drainage (remove ascites if present)
*Treat pain and adequately sedate
*Treat pain and adequately sedate
*Reverse Trendelenburg
*Reverse Trendelenburg
*Consider [[metoclopramide]]
*Consider [[Special:MyLanguage/metoclopramide|metoclopramide]]
 
 
===Operative=== <!--T:19-->


===Operative===
<!--T:20-->
''Definitive treatment''
''Definitive treatment''
*Laparotomy provides decompression
*Laparotomy provides decompression
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**No guidelines for timing of closure
**No guidelines for timing of closure


==Disposition==
 
==Disposition== <!--T:21-->
 
<!--T:22-->
*Admit
*Admit


==See Also==
*"Traditional" [[compartment syndrome]]


==External Links==
==See Also== <!--T:23-->
 
<!--T:24-->
*"Traditional" [[Special:MyLanguage/compartment syndrome|compartment syndrome]]
 
 
==External Links== <!--T:25-->
 
 
==References== <!--T:26-->


==References==
<!--T:27-->
<references/>
<references/>


<!--T:28-->
[[Category:GI]]
[[Category:GI]]
[[Category:Surgery]]
[[Category:Surgery]]
[[Category:Critical Care]]
[[Category:Critical Care]]
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Latest revision as of 21:30, 4 January 2026

Other languages:

Background

Lateral view showing abdominopelvic cavity.
  • Organ dysfunction caused by intrabdominal hypertension
  • Increased intrabdominal pressure resulting in decreased organ perfusion, impaired hemodynamics


Pathophysiology

  • Abdominal perfusion pressure = MAP - intrabdominal pressure
  • Build up of fluid or blood within the peritoneum or retroperitoneum
    • And/or decrease in abdominal wall compliance
  • Increased pressure within cavity of fixed volume → hypoperfusion of abdominal organs
    • Also causes restriction of diaphragmatic excursion and impaired central venous return


Causes


Clinical Features

  • Most patients are critically ill and unable to communicate
  • Decreased central venous return
    • Increased JVP
    • Increased ICP
    • Decreased cardiac preload
    • Increased cardiac afterload
  • Increased intrathoracic pressure
    • Decreased lung compliance (will cause high peak pressures in vented patients)
    • Decreased functional residual capacity
    • Worsened V/Q mismatch
  • Oliguria, renal failure
  • Bowel ischemia


Differential Diagnosis

Abdominal Trauma


Evaluation

Abdominal compartment syndrome caused by bulimia post vomiting. CT shows dilated stomach with food and air pressed other visceral organs and major abdominal vessels.
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.

Workup

Physical exam is neither sensitive nor specific

Link to steps on how to measure bladder pressure with arterial line and video.
  • Obtain bladder pressure
    • Normal = <12 mmHg
    • Intra-abdominal hypertension (IAH) = 12 - 20 mmHg
    • Concern for abdominal compartment syndrome = >20 mmHg (also requires evidence of end-organ damage)


Diagnosis

  • Abdominal compartment syndrome = IAH >20 mmHg PLUS end-organ damage
  • Abdominal perfusion pressure <60 mmHg suggests abdominal hypoperfusion[1]
  • 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[2]


Management

Nonoperative

Often first line approach when no abdominal injury present[3]


Operative

Definitive treatment

  • Laparotomy provides decompression
    • High complication rate
    • No guidelines for timing of closure


Disposition

  • Admit


See Also


External Links

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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 & Outcomes, 8(1).
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