Abdominal compartment syndrome

Last updated: February 2, 2023

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Abdominal compartment syndrome (ACS) is caused by increased pressure in the abdominal cavity (i.e., intraabdominal hypertension) and is most commonly seen in critically ill or injured patients. ACS can be caused by reduced abdominal wall compliance, visceral edema, increased luminal contents, or increased abdominal contents and manifests with organ dysfunction, including acute kidney failure, respiratory failure, and shock. Diagnosis is made with urinary bladder pressure measurement, which provides an indirect measure of intraabdominal pressure. Initial conservative measures are aimed at improving abdominal wall compliance, reducing abdominal cavity volume, and optimizing fluid balance and organ perfusion. If these measures fail to lower intraabdominal pressure, urgent decompressive laparotomy is required, typically followed by temporary abdominal closure.

For compartment syndromes of the extremities, see “Acute compartment syndrome” and “Chronic compartment syndrome.”

  • Intraabdominal pressure (IAP): the pressure within the abdominal compartment; normally < 12 mm Hg
  • Intraabdominal hypertension (IAH): a sustained or recurrent elevation of IAP to ≥ 12 mm Hg
  • Abdominal compartment syndrome: a sustained IAP > 20 mm Hg that is associated with organ dysfunction

Increased intraabdominal pressure → organ dysfunction [1][3]

Symptoms typically manifest acutely or subacutely in critically ill patients. [3]

Urinary bladder pressure measurement [1][2][4]

Additional diagnostics

Additional diagnostics are used to assess severity and identify underlying causes.

Maintain a low threshold for monitoring urinary bladder pressure in at-risk patients because the physical exam is not reliable in detecting raised intraabdominal pressure. [1][2]

Approach [1][4]

  • All patients
    • ICU admission for IAP monitoring and medical management
    • Treatment of the underlying condition (e.g., sepsis management)
  • Refractory ACS: urgent surgical decompression

Monitor IAP continuously or every 4–6 hours and titrate interventions to a target IAP of ≤ 15 mm Hg. [1]

Medical and supportive therapy [1][4]

Surgical treatment [1][2][4]

  1. Kirkpatrick AW, Roberts DJ, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013; 39 (7): p.1190-1206. doi: 10.1007/s00134-013-2906-z . | Open in Read by QxMD
  2. Roberts DJ, Ball CG, Kirkpatrick AW. Increased pressure within the abdominal compartment. Curr Opin Crit Care. 2016 : p.1. doi: 10.1097/mcc.0000000000000289 . | Open in Read by QxMD
  3. Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. Elsevier ; 2016
  4. De Laet IE, Malbrain MLNG, De Waele JJ. A Clinician’s Guide to Management of Intra-abdominal Hypertension and Abdominal Compartment Syndrome in Critically Ill Patients. Crit Care. 2020; 24 (1). doi: 10.1186/s13054-020-2782-1 . | Open in Read by QxMD
  5. Patel A, Lall CG, Jennings SG, Sandrasegaran K. Abdominal Compartment Syndrome. Am J Roentgenol. 2007; 189 (5): p.1037-1043. doi: 10.2214/ajr.07.2092 . | Open in Read by QxMD
  6. Padar M, Reintam Blaser A, Talving P, Lipping E, Starkopf J. Abdominal Compartment Syndrome: Improving Outcomes With A Multidisciplinary Approach – A Narrative Review. J Multidiscip Healthc. 2019; Volume 12 : p.1061-1074. doi: 10.2147/jmdh.s205608 . | Open in Read by QxMD
  7. Coccolini F, Roberts D, Ansaloni L, et al. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J Emerg Surg. 2018; 13 (1). doi: 10.1186/s13017-018-0167-4 . | Open in Read by QxMD

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