Abdominal compartment syndrome

Background

  • 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 intrathoracic pressure
    • Decreased lung compliance
    • Decreased functional residual capacity
    • Worsened V/Q mismatch
  • Oliguria, renal failure
  • Bowel ischemia

Differential Diagnosis

Abdominal Trauma

Evaluation

Physical exam is neither sensitive nor specific

  • Obtain bladder pressure
    • Measurement >20mmHg WITH new organ dysfunction is indicative of compartment syndrome

Management

Nonoperative

Often first line approach when no abdominal injury present[1]

Operative

Definitive treatment

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

Disposition

  • Admit

See Also

References

  1. 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).