Abdominal compartment syndrome and the open abdomen

2017 ◽  
Vol 23 (1) ◽  
pp. 73-78 ◽  
Author(s):  
Michael Sugrue
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Open Abdomen ◽  
Abdominal Compartment

scholarly journals Interventional and surgical management of abdominal compartment syndrome in severe acute pancreatitis

Medicina ◽  
2010 ◽  
Vol 46 (4) ◽  
pp. 249 ◽  
Author(s):  
Žilvinas Dambrauskas ◽  
Audrius Paršeliūnas ◽  
Almantas Maleckas ◽  
Antanas Gulbinas ◽  
Giedrius Barauskas ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Surgical Management ◽  
Severe Acute Pancreatitis ◽  
Open Abdomen ◽  
Ultrasound Guided ◽  
Management Protocol ◽  
Fluid Collections ◽  
Abdominal Compartment

Background and objective. Management of the abdominal compartment syndrome during severe acute pancreatitis by the open abdomen method is associated with considerable morbidity and resource utilization. Thus, the aim of this study was to evaluate the safety and efficacy of the ultrasound-guided percutaneous interventions and/or minimally invasive surgery in the treatment of abdominal compartment syndrome. Material and methods. Forty-four patients with severe acute pancreatitis were enrolled into a prospective study and treated according to the standard management protocol. Interventional and/ or surgical management of abdominal compartment syndrome was employed in 6 (13.6%) cases. In the context of this study, we assessed the feasibility and effectiveness of subcutaneous fasciotomy of the anterior m. rectus abdominis sheath, as well as the role of ultrasound-guided drainage of intra-abdominal and peripancreatic fluid collections in the management of abdominal compartment syndrome. Results. Subcutaneous fasciotomy of the anterior m. rectus sheath and ultrasound-guided drainage of intra-abdominal and peripancreatic fluid collections seem to be safe (minor risk of bleeding or infection, closed abdomen, and easy care for the patient) and effective (resulted in a sustained decrease of intra-abdominal pressure to 13–16 mm Hg and regression of organ failures after intervention). Subcutaneous anterior m. rectus fasciotomy may appear to be beneficial in case of refractory abdominal compartment syndrome avoiding morbidity associated with the open abdomen technique. Conclusions. Both the subcutaneous fasciotomy and ultrasound-guided drainage of intra-abdominal and/or peripancreatic fluid collections seem to be safe and effective alternatives in the management of abdominal compartment syndrome; however, prospective studies are needed to further evaluate their clinical role.

scholarly journals Open Abdomen during Extracorporeal Membrane Oxygenation is a Safe and Effective Treatment for Abdominal Compartment Syndrome

2020 ◽  
Vol 3 ◽  
Author(s):  
Joshua Brown ◽  
Brielle Warnock ◽  
Eamaan Turk ◽  
Gail Hocutt ◽  
Brian Gray
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Open Abdomen ◽  
Surgical Patients ◽  
Bleeding Complications ◽  
Decompressive Laparotomy ◽  
Abdominal Compartment ◽  
Ecmo Treatment ◽  
Surgical Group

Background/Purpose                                                                    Historically, decompressive laparotomy and open abdomen for abdominal compartment syndrome has contraindicated Extracorporeal Membrane Oxygenation (ECMO) due to seemingly high risk of bleeding and infection. The literature shows few examples of this treatment, and the existing studies are inconclusive. The purpose of this study was to review the series at Riley Hospital for Children and evaluate the effectiveness of ECMO treatment for patients undergoing decompressive laparotomy with open abdomen to recommend future care guidelines.   Methods                          We reviewed all pediatric (30 days to 18 years) patients treated with ECMO concurrently with decompressive laparotomy and open abdomen at Riley Hospital for Children from 2000-2019. We compared these patients with non-surgical pediatric patients supported with ECMO for respiratory failure at Riley Hospital for Children during the same period. Demographics, ECMO data, and outcomes were assessed. We performed t-test, ROC, and chi-square analyses. We defined significance as p=0.05.   Results                      5 of 82 pediatric respiratory ECMO patients were treated with decompressive laparotomy and open abdomen. Survival among the surgical group was 60%, compared to 57% in the non-surgical group (p=0.9). Surgical patients had a similar incidence of bleeding complications (40%) compared to non-surgical patients (55.8%), p=0.486. Surgical patients had a significantly higher VIS (3126 vs 19.2, p=0.004), PaO2/FiO2 ratio (279.0 vs 72.9, p=0.031), and pump flow rate at 24hrs (112mL/kg/min vs 88.1mL/kg/min, p=0.045) than non-surgical patients, while receiving a similar volume of PRBCs (p=0.581) and requiring ECMO treatment for a similar amount of time (p=0.511).   Conclusion/Potential Impact                          ECMO support in patients with decompressive laparotomy and open abdomen was associated with similar survival and bleeding complications compared to non-surgical ECMO patients. ECMO should be offered to or continued in eligible patients with abdominal catastrophe, as it is effective in supporting organ function while not significantly increasing the risk for complications. 

Sign in / Sign up

Export Citation Format

Share Document