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Abdominal compaACS) 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.ome (
- Reduced abdominal wall compliance
- Massive volume resuscitation
- Increased luminal contents
- Increased abdominal contents
- Primary: associated with abdominopelvic injury or disease (e.g., abdominal trauma or surgery, acute pancreatitis)
- Secondary: associated with conditions that are not due to a primary abdominopelvic pathology (e.g., caused by sepsis and/or aggressive fluid resuscitation)
- Recurrent: reoccurrence after treatment of primary or secondary abdominal compartment syndrome
Urinary bladder pressure measurement 
- Gold standard test that provides indirect measurement of intraabdominal pressure 
- Indications: risk factors for IAH or abdominal compartment syndrome in a critically ill patient
- Frequency: continuously or every 4–6 hours
Additional diagnostics are used to assess severity and identify underlying causes.
- Laboratory studies
- All patients
- Refractory ACS: urgent surgical decompression
Medical and supportive therapy 
- Removal of constrictive dressings
- Optimization of body position
- Adequate sedation and analgesia
- Reduction of enteral nutrition/NPO
- Placement of nasogastric and/or rectal tube
- Paracentesis and/or percutaneous drainage of fluid collections
- Diuresis and/or ultrafiltration
Surgical treatment 
- Indication: ACS refractory to medical management
- Techniques 
- Laparotomy for abdominal decompression
- Delayed definitive closure
- ICU admission
- Urgent general surgery consult
- Measure IAP continuously or every 4–6 hours.
- Initiate medical and supportive therapy.
- Consider urgent surgical decompression if refractory to medical management.