Intra-abdominal Hypertension and Abdominal Compartment Syndrome in patients undergoing emergency laparotomy

  • Malik Irfan Ahmed RAWALPINDI MEDICAL UNIVERSITY
  • Muhammad Waqas Raza RAWALPINDI MEDICAL UNIVERSITY
  • Fazal Hussain Shah
  • Muhammad Hanif
  • Khalid Shahzad
  • Muhammad Mussadiq Khan
Keywords: Abdominal trauma, peritonitis, Intra-abdominal pressure (IAP), Intra-abdominal hypertension (IAH), abdominal compartment syndrome (ACS).

Abstract

Objective: The objectives of the Prospective observational study were to identify the frequency of abdominal compartment syndrome and intraabdominal hypertension in patients undergoing emergency laparotomy for trauma and peritonitis and to determine the impact of raised intraabdominal pressure on the overall morbidity and mortality.

Materials and Methods: The study was conducted in the department of surgery Benazir Bhutto Hospital Rawalpindi. From June 2013 to May 2014 a total of 50 patients undergoing emergency laparotomy were included. IAP was measured preoperatively then postoperatively at 0, 6, 24 hours, and the findings were recorded on a specially designed preform. The patients having higher IAP were further evaluated up to 72 hours. All vitals, urine output, oxygen saturation, serum urea, creatinine were noted. The main outcomes were duration of hospital stay, the occurrence of burst abdomen, and mortality.

Results: At the preoperative level the incidence of IAH was 86%. The mortality association with IAH at 6 hours postoperatively was quite significant (P<0.029). The incidence of postoperative ACS was 5% among the total patients and it was 15.6% in trauma patients. No significant association was found between IAP and occurrence of burst abdomen at any level (P values 0.4, 0.26, 0.53, 0.58 at intervals preoperatively, 0, 6, 24 hours postoperative respectively. 

Conclusion: Intraabdominal pressure is an important factor that predicts the mortality of patients undergoing emergency laparotomy. It should be carefully monitored and managed accordingly to avoid the detrimental effects on virtually all organ systems. Abdominal decompression in significantly elevated intraabdominal pressure reverts the physiological derangement of Intrabdominal hypertension.

Author Biography

Muhammad Waqas Raza, RAWALPINDI MEDICAL UNIVERSITY

Associate Professor of Surgery, Rawalpindi Medical University.

References

1. Santa-Teresa P, Munoz J, Montero I, Zurita M, Tomey M, Alvarez-Sala L, et al. Incidence and prognosis of intra-abdominal hypertension in critically ill medical patients: a prospective epidemiological study. Ann Intensive Care. 2012; 2 Suppl 1(2): S3.
2. Papavramidis TS, Marinis AD, Pliakos I, Kesisoglou I, Papavramidou N. Abdominal compartment syndrome - Intra-abdominal hypertension: Defining, diagnosing, and managing. J Emerg Trauma Shock. 2011; 4(2):279-91.
3. Khan S, Verma AK, Ahmad SM, Ahmad R. Analyzing intra-abdominal pressures and outcomes in patients undergoing emergency laparotomy. J Emerg Trauma Shock. 2010; 3(4):318-25.
4. De Laet IE, Malbrain M. Current insights in intra-abdominal hypertension and abdominal compartment syndrome. Med Intensiva. 2007; 31(2):88-99.
5. Onichimowski D, Podlinska I, Sobiech S, Ropiak R. [Measurement of the intra-abdominal pressure in clinical practice]. Anestezjol Intens Ter. 2010;42(2):107-12.
6. Zhou JC, Zhao HC, Pan KH, Xu QP. Current recognition and management of intra-abdominal hypertension and abdominal compartment syndrome among tertiary Chinese intensive care physicians. J Zhejiang Univ Sci B. 2011;12(2):156-62.
7. Bozkurt MA, Temizgonul KB, Kones O, Alis H. A rare reason of abdominal compartment syndrome: non-Hodgkin lymphoma. J Korean Surg Soc. 2012;83(4):242-5.
8. Sanchez-Miralles A, Castellanos G, Badenes R, Conejero R. [Abdominal compartment syndrome and acute intestinal distress syndrome]. Med Intensiva. 2013;37(2):99-109.
9. Luckianow GM, Ellis M, Governale D, Kaplan LJ. Abdominal compartment syndrome: risk factors, diagnosis, and current therapy. Crit Care Res Pract. 2012;2012(10):908169.
10. Cheatham ML. Abdominal compartment syndrome: pathophysiology and definitions. Scand J Trauma Resusc Emerg Med. 2009;17(10):10.
11. Esquis P, Consolo D, Magnin G, Pointaire P, Moretto P, Ynsa MD, et al. High intra-abdominal pressure enhances the penetration and antitumor effect of intraperitoneal cisplatin on experimental peritoneal carcinomatosis. Annals of surgery. 2006;244(1):106-12.
12. Mohmand H, Goldfarb S. Renal dysfunction associated with intra-abdominal hypertension and the abdominal compartment syndrome. J Am Soc Nephrol. 2011;22(4):615-21.
13. Serpytis M, Ivaskevicius J. [Intra-abdominal hypertension and multiple organ dysfunction syndrome]. Medicina (Kaunas). 2005;41(11):903-9.
14. Cheatham ML, White MW, Sagraves SG, Johnson JL, Block EF. Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. The Journal of trauma. 2000;49(4):621-6; discussion 6-7.
15. Sugrue M, Buist MD, Hourihan F, Deane S, Bauman A, Hillman K. Prospective study of intra-abdominal hypertension and renal function after laparotomy. The British journal of surgery. 1995;82(2):235-8.
16. Hong JJ, Cohn SM, Perez JM, Dolich MO, Brown M, McKenney MG. Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome. The British journal of surgery. 2002;89(5):591-6.
17. Meldrum DR, Moore FA, Moore EE, Franciose RJ, Sauaia A, Burch JM. Prospective characterization and selective management of the abdominal compartment syndrome. American journal of surgery. 1997;174(6):667-72; discussion 72-3.
18. 18. Ivatury RR, Sugerman HJ, Peitzman AB. Abdominal compartment syndrome: recognition and management. Advances in surgery. 2001;35:251-69.
19. 19. Ma YM, Qian C, Xie F, Zhou FH, Pan L, Song Q. [Acute renal failure due to abdominal compartment syndrome]. Zhonghua yi xue za zhi. 2005;85(31):2218-20.
20. Ball CG, Kirkpatrick AW. Intra-abdominal hypertension and the abdominal compartment syndrome. Scand J Surg. 2007;96(3):197-204.
21. Chiara O, Cimbanassi S, Boati S, Bassi G. Surgical management of abdominal compartment syndrome. Minerva Anestesiol. 2011;77(4):457-62.
22. Chiumello D, Tallarini F, Chierichetti M, Polli F, Li Bassi G, Motta G, et al. The effect of different volumes and temperatures of saline on the bladder pressure measurement in critically ill patients. Crit Care. 2007; 11(4):R82.
Published
2020-09-30
How to Cite
1.
Ahmed M, Raza M, Shah F, Hanif M, Shahzad K, Khan M. Intra-abdominal Hypertension and Abdominal Compartment Syndrome in patients undergoing emergency laparotomy. JRMC [Internet]. 30Sep.2020 [cited 22Oct.2020];24(3):254-9. Available from: http://journalrmc.com/index.php/JRMC/article/view/1387