ABDOMINAL COMPARTMENT SYNDROME

Abstract

Intra-abdominal hypertension adversely affected almost all body systems, most notably the cardiac, respiratory, renal and hepatic systems. These physiologic aberrations may result in organ dysfunction and failure. Intra-abdominal hypertension was characterized clinically by the evolution of progressive respiratory embracement, tense distended abdomen and progressive oliguria and if untreated,rapid progression of IAH will lead to ACS, which is characterized by multiple system organ dysfunctions and may be fatal. The adverse physiologic effects are rapidly reversed by proper management and surgical decompression. The mortality of ACS is high. Recognizing patients at risk, monitoring for signs of ACS and early initiation of treatment could help to reduce the morbidity and mortality of the syndrome. Given the broad range of potential etiological factors and the significant associated morbidity and mortality of IAH/ACS, a high index of suspicion and low threshold for IAP measurement appears appropriate. IAH and ACS had many causes, not only as a complication of trauma or damage control surgeries, but also can happen due to neglected non-trauma causes, so we should raise the clinical awareness of their pathophysiology and management as they required the coordination of multiple therapies, investigations and interventions over a protracted time. Diagnosis of ACS required a high index of suspicion and familiarity with its presenting signs. However, clinical examination wasn’t thought to be an accurate indicator of IAP. IAH didn’t necessarily lead to ACS and often resolved without clinical sequel. ACS developed when cases with IAH neglected or late presentation of such patients which may be fatal. Serial measurements of intra-abdominal pressure evidenced the clinical severity of the disease. Intra-abdominal pressure measurement may be used as a predictor of exploration in patients presenting acute abdominal compartment syndrome. Several methods were available to measure intra-abdominal pressure and it is easily performed by bladder pressure measurement which appeared reliable. We recommend routine bladder pressure measurement for patients at risk for IAH and maintaining a low threshold to check for bladder pressures. Early initiation of treatment for intra-abdominal hypertension is currently advocated in view of the possibility of subclinical progress to the full-blown abdominal compartment syndrome.