Recent trends in management of Abdominal compartment syndrome

Abstract

SUMMARY T he expansion of substance within a compartment of relatively fixed volume creates an increase in intra-compartmental pressure. Elevated intra-abdominal pressure leads directly to progressive organ dysfunction in the intestinal, renal, pulmonary, and cardiovascular and central nervous systems. Progressive increase in IAP to levels above 20–25 mmHg, with associated organ failure, is defined as the abdominal compartmental syndrome (ACS). This syndrome occurs with equal prevalence in surgical and medical intensive care units. Early detection of IAH allows the clinician to manage this condition with medical therapies or by surgical intervention. The World Society of Abdominal Compartmental Syndrome, (2009) defined the intra-Abdominal Hypertension (IAH) as Intra-Abdominal Pressure (IAP) above 12 mm Hg; Three types of abdominal Compartmental syndrome are recognized; Primary, Secondary and chronic ACS. The diagnosis of ACS depends on a very high degree of suspicious and recognition of the patients at risk, identification of clinical syndrome and lastly measurement of IAP. The Second World Congress of Abdominal Compartment Syndrome proposed the following indications for measuring of (IAP) for example, Postoperative abdominal surgery patient with a distended abdomen, patient with open or blunt abdominal trauma and mechanically ventilated ICU patient with other organ dysfunction. Different ways of measurement of the (IAP) are known to be used, the Urinary bladder pressure this is simple, minimally invasive method can be easily performed at the bedside The clinician must be able to evaluate the patient and the IAP reading to determine if either a medical or surgical intervention is necessary. Several non-interventional strategies have been used and hold promises in preventing further complications leading to ACS for example, evacuation of intraluminal contents, evacuation of extra luminal contents, use of sedation and neuromuscular blockers, octreotide and recntly continuous negative abdominal pressure. An important term to remember is that IAH is an urgent medical disease whereas ACS is an urgent surgical disease. Sustained IAH >20 mmHg with at least one organ in dysfunction necessitates surgical decompression in order to reduce further problems associated with ACS Operative decompression is achieved by abdominal fasciotomy and covering the fascial gap with mesh. All meshes help to effectively decompress the abdomen. Several techniques in the surgical treatment are available