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Surgical decompression for the management of abdominal compartment syndrome with severe acute pancreatitis: A narrative review

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世界胃肠外科杂志:英文版(电子版) 2023年第9期15卷 1879-1891页

作者： Prashant Nasa Gunjan Chanchalani Deven Juneja Manu LNG Malbrain Department of Critical Care Medicine NMC Specialty HospitalDubai 7832United Arab Emirates Department of Internal Medicine College of Medicine and Health SciencesAl Ain 15551United Arab Emirates Department of Critical Care Medicine K.J.Somaiya Hospital and Research CentreMumbai 400022India Institute of Critical Care Medicine Max Super Specialty HospitalNew Delhi 110017India First Department of Anaesthesiology and Intensive Therapy Medical University of LublinLublin 20-954Poland Executive Administration International Fluid AcademyLovenjoel 3360Belgium Medical Data Management MedamanGeel 2440Belgium

Intra-abdominal hypertension(IAH)and abdominal compartment syndrome(ACS)play a pivotal role in the pathophysiology of severe acute pancreatitis(SAP)and contribute to new-onset and persistent organ failure.The optimal management of ACS involves a multi-disciplinary approach,from its early recognition to measures aiming at an urgent reduction of intra-abdominal pressure(IAP).A targeted literature search from January 1,2000,to November 30,2022,revealed 20 studies and data was analyzed on the type and country of the study,patient demographics,IAP,type and timing of surgical procedure performed,post-operative wound management,and outcomes of patients with ACS.There was no randomized controlled trial published on the ***-pressive laparotomy is effective in rapidly reducing IAP(standardized mean difference=2.68,95%confidence interval:1.19-1.47,Pabdominal compartment Society on IAH and ACS.This narrative review focuses on the current evidence regarding surgical decompression techniques for managing ACS in patients with SAP.However,there is a lack of high-quality evidence on patient selection,timing,and modality of surgical decompression.Large prospective trials are needed to identify triggers and effective and safe surgical decompression methods in SAP patients with ACS.

关键词： Intra-abdominal hypertension Intra-abdominal pressure Decompression laparotomy Midline laparotomy abdominal compartment syndrome Acute pancreatitis

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abdominal compartment syndrome:Often overlooked conditions in medical intensive care units

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World Journal of Gastroenterology 2020年第3期26卷 266-278页

作者： Venkat Rajasurya Salim Surani Department of Pulmonary and Critical Care Novant Health SystemWinston-SalemNC 27103United States Department of Pulmonary Critical Care and Sleep Medicine Texas A&M Health Science CenterBryanTX 77807United States

Intra-abdominal hypertension(IAH)and abdominal compartment syndrome are well recognized entities among surgical patients.Nevertheless,a number of prospective and retrospective observational studies have shown that IAH is prevalent in about half of the critically ill patients in the medical intensive care units(ICU)and has been widely recognized as an independent risk factor for mortality.It is alarming to note that many members of the critical care team in medical ICU are not aware of the consequences of untreated IAH and the delay in making the diagnosis leads to increased morbidity and mortality.Frequently it is underdiagnosed and undertreated in this patient population.Elevated intraabdominal pressure decreases the blood flow to the kidneys and other abdominal viscera and also results in reduced cardiac output and difficulties in ventilating the patient because of increased intrathoracic pressure.When intraabdominal hypertension is not promptly recognized and treated,it leads to abdominal compartment syndrome,multiorgan dysfunction syndrome and death.Large volume fluid resuscitation is very common in medical ICU patients presenting with sepsis,shock and other inflammatory conditions like pancreatitis and it is one of the major risk factors for the development of intra-abdominal hypertension.This article presents an overview of the epidemiology,definitions,risk factors,pathophysiology and management of IAH and abdominal compartment syndrome in critically ill medical ICU patients.

关键词： Intra-abdominal pressure Intra-abdominal hypertension abdominal compartment syndrome Acute kidney injury Large volume resuscitation Open abdomen Bladder pressure Medical intensive care unit

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abdominal compartment syndrome among surgical patients

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World Journal of Gastrointestinal Surgery 2021年第4期13卷 330-339页

作者： Monica Leon Luis Chavez Salim Surani Department of Medicine Centro Medico ABCCiudad de Mexico 01120Mexico Department of Medicine University of TexasEl PasoTX 79905United States Department of Medicine Texas A&M UniversityCorpus ChristiTX 78405United States

abdominal compartment syndrome(ACS)develops when organ failure arises secondary to an increase in intraabdominal pressure.The abdominal pressure is determined by multiple factors such as blood pressure,abdominal compliance,and other factors that exert a constant pressure within the abdominal cavity.Several conditions in the critically ill may increase abdominal pressure compromising organ perfusion that may lead to renal and respiratory dysfunction.Among surgical and trauma patients,aggressive fluid resuscitation is the most commonly reported risk factor to develop ACS.Other conditions that have also been identified as risk factors are ascites,hemoperitoneum,bowel distention,and large tumors.All patients with abdominal trauma possess a higher risk of developing intra-abdominal hypertension(IAH).Certain surgical interventions are reported to have a higher risk to develop IAH such as damage control surgery,abdominal aortic aneurysm repair,and liver transplantation among others.Close monitoring of organ function and intra-abdominal pressure(IAP)allows clinicians to diagnose ACS rapidly and intervene with target-specific management to reduce IAP.Surgical decompression followed by temporary abdominal closure should be considered in all patients with signs of organ dysfunction.There is still a great need for more studies to determine the adequate timing for interventions to improve patient outcomes.

关键词： Intra-abdominal hypertension abdominal compartment syndrome Intraabdominal pressure Open abdomen treatment Multiple organ failure Surgical decompression

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Hemorrhoid sclerotherapy with the complication of abdominal compartment syndrome： report of a case

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Chinese Medical Journal 2011年第12期124卷 1919-1920页

作者： YANG Peng WANG Ya-jun LI Fei SUN Jia-bang Department of General Surgery Xuan Wu Hospital CapitalMedical University Beijing 100053 China

The complications of injection sclerotherapy for hemorrhoid are always local. Herein, we report a case in which a female patient with abdominal compartment syndrome developed after receiving a local injection of a scl... 详细信息

关键词： hemorrhoid sclerotherapy complication abdominal compartment syndrome

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Should we perform decompressive laparotomy during severe acute pancreatitis with intra-abdominal hypertension below 25 mmHg:Only the gut knows

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World Journal of Gastrointestinal Surgery 2024年第5期16卷 1470-1473页

作者： Thibault Vieille Melissa Crotet Celia Turco Paul Monasterolo Hadrien Winiszewski Gael Piton Medical Intensive Care Unit Besancon University HospitalBesancon 25000France Intensive Care Unit Vesoul HospitalVesoul 70000France Department of Digestive Surgical Oncology-Liver Transplantation Unit Besancon University HospitalBesancon 25000France Inserm UMRS-938 Centre de Recherche Saint-Antoine(CRSA)Sorbonne UniversitéParis 10041NY212France Intensive Care Unit Nord Franche Comte HospitalTrevenans 90400France

We suggest that during severe acute pancreatitis(SAP)with intra-abdominal hypertension,practitioners should consider decompressive laparotomy,even with intra-abdominal pressure(IAP)below 25 mmHg.Indeed,in this setting,non-occlusive mesenteric ischemia(NOMI)may occur even with IAP below this cutoff and lead to transmural necrosis if abdominal perfusion pressure is not promptly restored.We report our experience of 18 critically ill patients with SAP having undergone decompressive laparotomy of which one third had NOMI while IAP was mostly below 25 mmHg.

关键词： Acute pancreatitis abdominal compartment syndrome Decompressive laparotomy Mesenteric ischemia Intra-abdominal pressure abdominal perfusion pressure

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Epstein-Barr virus associated secondary hemophagocytic lymphohistiocytosis with an unusual presentation of abdominal compartment syndrome

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Hepatoma Research 2016年第1期2卷 287-292页

作者： Li Lei Camilla J.Cobb Jeffrey Cao Anwar S.Raza Department of Pathology and Human Anatomy Loma Linda University Medical CenterLoma LindaCA 92354USA

Hemophagocytic lymphohistiocytosis(HLH)is a cytokine storm syndrome caused by an overactive but ineffective immune reaction.Without prompt diagnosis and treatment,HLH is life-threatening.However,presenting symptoms are often nonspecific,with fatigue and fever being the most common.A high index of suspicion is therefore critical for early diagnosis and timely management.A previously healthy,65-year-old female who initially presented with fever and abdominal pain developed abdominal compartment syndrome(ACS)requiring decompressive laparotomy on hospital day 6.Intraoperative frozen sections of biopsied liver showed intense portal lymphohistiocytic infiltrates.Epstein-Barr virus DNA copy numbers escalated from 600 copies/mL after admission to 134,000 copies/mL before death.The diagnostic criteria of HLH-2004 were met.Patient expired on hospital day 12.It is important to raise awareness of ACS being an unusual presentation of HLH.Recent changes in diagnostic criteria tailored to adult HLH cases are reviewed.

关键词： Hemophagocytic lymphohistiocytosis abdominal compartment syndrome liver biopsy Epstein-Barr virus

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abdominal compartment syndrome resulting from postpartum hematoma of wall:A rare occurrence associated with a seldom,but high risk of mortality

Abdominal compartment syndrome resulting from postpartum hem...

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2015年浙江省外科学学术年会暨国家级肝胆胰疾病诊治进...

作者： Wang Pin Jia Zhong the Chinese Medical Association the Chinese Medical Association Group of Hhernia and Aabdominal Wwall

Objective:To analyze and summarize the clinical features and diagnosis and treatment of postpartum abdominal hemorrhage with abdominal compartment syndrome(ACS),in order to improve its diagnosis and treatment.Methods:A retrospective analysis of the clinical data of the four cases of postpartum abdominal hemorrhage with ACS treated in our hospital of from 2009 to 2014 in our hospital,through the clinical data and treatment.Results:PPostpartum ACS and is characterized by excessive Postpartum bleedingblood loss related.Symptoms mMainly as included oliguria,abdominal distention,shortness of breath,etc.;progressive decrease in hhemoglobin,and hematocrit progressively decreased,coagulation disorders;,large volumes of ascites on CT computed tomography and B-type ultrasonography,and significant increases in and B-prompted a large number of ascites fluid accumulation or in part;intra-abdominal pressure,increased significantly,4A11 four patients were takingunderwent surgical decompression and hemostasis,including 1 one case of intestinal necrosis caused by ACS,.Two 2 patients were curedfully recovered,while two 1 patients died:one due to acute respiratory distress syndromeARDS,1 and one from patient died due to lupus encephalopathy.Conclusion:Postpartum hemorrhage can cause lead to abdominal ACS,which is maternal life-threatening,.Physicians should attach great importance to timely diagnosis of this phenomena and early surgical decompression is the key to successful treatment.

关键词： postnatal abdominal compartment syndrome ACS abdominal hemorrhage

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Embryonic natural orifice transluminal endoscopic surgery in the treatment of severe acute pancreatitis complicated by abdominal compartment syndrome

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World Journal of Emergency Medicine 2015年第1期6卷 23-28页

作者： Hui-ming Zhu Shao-qing Guo Xiu-min Liao Li Zhang Li Cai Department of Gastroenterology Affiliated Donghua Hospital of Sun Yat-sen University

BACKGROUND: The study aimed to estimate the value of embryonal natural orifice transluminal endoscopic surgery(ENOTES) in treating severe acute pancreatitis(SAP) complicated with abdominal compartment syndrome(ACS).METHODS: The patients, who were randomized into an ENOTES group and an operative group, underwent ENOTES and laparotomy, respectively. The results and complications of the two groups were compared.RESULTS: Enterocinesia was observed earlier in the ENOTES group than in the operative group. Acute Physiology and Chronic Health Evaluation II(APACHE II) score of patients in the ENOTES group was lower than that of the operative group on the 1st, 3rd and 5th post-operative day(P<0.05). The cure rate was 96.87% in the ENOTES group, which was statistically different from 78.12% in the operative group(P<0.05). There were significant differences in complications and mortality between the two groups(P<0.01).CONCLUSION: Compared with surgical decompression, ENOTES associated with flexible endoscope therapy is an effective and minimal invasive procedure with less complications.

关键词： Embryonal natural orifi ce transluminal endoscopic surgery Flexible endoscope Peritoneal lavage Peritoneal dialysis Severe acute pancreatitis abdominal compartment syndrome

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Elevated intra-abdominal pressure:A review of current knowledge

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World Journal of Clinical Cases 2022年第10期10卷 3005-3013页

作者： Piotr Łagosz Mateusz Sokolski Jan Biegus Agnieszka Tycinska Robert Zymlinski Department of Heart Diseases Wroclaw Medical UniversityWroclaw 50-367Poland Institute of Heart Diseases University Clinical HospitalWroclaw 50-556Poland Department of Cardiology Medical University of BialystokBialystok 15-089Poland

Elevated intra-abdominal pressure(IAP)is a known cause of increased morbidity and mortality among critically ill patients.Intra-abdominal hypertension(IAH)and abdominal compartment syndrome can lead to rapid deterioration of organ function and the development of multiple organ failure.Raised IAP affects every system and main organ in the human body.Even marginally sustained IAH results in malperfusion and may disrupt the process of recovery.Yet,despite being so common,this potentially lethal condition often goes unnoticed.In 2004,the World Society of the abdominal compartment syndrome,an international multidisciplinary consensus group,was formed to provide unified definitions,improve understanding and promote research in this field.Simple,reliable and nearly costless standardized methods of non-invasive measurement and monitoring of bladder pressure allow early recognition of IAH and timely optimized management.The correct,structured approach to treatment can have a striking effect and fully restore homeostasis.In recent years,significant progress has been made in this area with the contribution of surgeons,internal medicine specialists and anesthesiologists.Our review focuses on recent advances in order to present the complex underlying pathophysiology and guidelines concerning diagnosis,monitoring and treatment of this life-threatening condition.

关键词： abdominal compartment syndrome Intra-abdominal hypertension Intra-abdominal pressure Multiple organ failure abdominal perfusion pressure

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Study of intra-abdominal hypertension prevalence and awareness level among experienced ICU medical staff

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Journal of Medical Colleges of PLA(China) 2016年第4期31卷 181-187页

作者： Hua-Yu Zhang Dong Liu Hao Tang Shi-Jin Sun Shan-Mu Ai Wen-Qun Yang Dong-Po Jiang Lian-Yang Zhang Trauma Center State Key Laboratory of TraumaBurns and Combined InjuryInstitute of Surgery ResearchDaping HospitalThird Military Medical University

Background:Intra-abdominal hypertension(IAH) is a disease with high morbidity and mortality among critically ill patients.The study's objectives were to explore the prevalence of IAH and physicians' awareness of the 2013 World Society of abdominal compartment syndrome(WSACS) guidelines in Chinese intensive care units(ICUs).Methods:A cross-sectional study of four ICUs in Southwestern China was conducted from June 17 to August 2,2014.Adult patients admitted to the ICU for more than 24 h,with bladder catheter but without obvious intravesical pressure(IVP) measurement contraindications,were recruited.Intensivists with more than 5 years of ICU working experience were also recruited.Epidemiological information,potential IAH risk factors,IVP measurements and questionnaire results were recorded.Results:Forty-one patients were selected.Fifteen(36.59%) had IVP?12mm Hg.SOFA(Sequential Organ Failure Assessment) hepatic and neurological sub-scores were utilized as independent predictors for IAH via logistic backward analysis.Thirty-seven intensivists participated in the survey(response rate:80.43%).The average score of each center was less than 35 points.All physicians believed the IAH prevalence in their departments was no more than 20.00%.A significant negative correlation was observed between the intensivists' awareness of the 2013 WSACS guidelines and the IAH prevalence in each center(r=-0.975,P=0.025).Conclusion:The prevalence and independent predictors of IAH among the surveyed population are similar to the reports in the literature.Intensivists generally have a low awareness of the 2013 WSACS guidelines.A systematic guideline training program is vital for improving the efficiency of the diagnosis and treatment of IAH.

关键词： Intra-abdominal pressure Intravesical pressure Intra-abdominal hypertension abdominal compartment syndrome Questionnaire

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