Abdominal compartment syndrome

Background

Organ dysfunction caused by intrabdominal hypertension
Increased intrabdominal pressure resulting in decreased organ perfusion, impaired hemodynamics

Pathophysiology

Abdominal perfusion pressure = MAP - intrabdominal pressure
Build up of fluid or blood within the peritoneum or retroperitoneum
- And/or decrease in abdominal wall compliance
Increased pressure within cavity of fixed volume → hypoperfusion of abdominal organs
- Also causes restriction of diaphragmatic excursion and impaired central venous return

Causes

Clinical Features

Most patients are critically ill and unable to communicate
Decreased central venous return
- Increased JVP
- Increased ICP
- Decreased cardiac preload
Increased intrathoracic pressure
- Decreased lung compliance
- Decreased functional residual capacity
- Worsened V/Q mismatch
Oliguria, renal failure
Bowel ischemia

Differential Diagnosis

Abdominal Trauma

Evaluation

Physical exam is neither sensitive nor specific

Obtain bladder pressure
- Measurement >20mmHg WITH new organ dysfunction is indicative of compartment syndrome

Management

Nonoperative

Often first line approach when no abdominal injury present[1]

Limit fluid resuscitation
Nasogastric and bladder decompression
Electrolyte repletion
Antibiotics
Pressors
CRRT
Percutaneous fluid drainage

Operative

Definitive treatment

Laparotomy provides decompression
- High complication rate
- No guidelines for timing of closure

Disposition

Admit

See Also

"Traditional" compartment syndrome

References

Hunt, L., Frost, S. A., Hillman, K., Newton, P. J. and Davidson, P. M. (2014) ‘Management of intra-abdominal hypertension and abdominal compartment syndrome: a review’, Journal of Trauma Management & Outcomes, 8(1).

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