Subcutaneous Linea Alba Fasciotomy: A Less Morbid Treatment for Abdominal Compartment Syndrome

2008 ◽  
Vol 74 (8) ◽  
pp. 746-749 ◽  
Author(s):  
Michael L. Cheatham ◽  
Jessica Fowler ◽  
Peter Pappas
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Injured Patient ◽  
Abdominal Pressure ◽  
Linea Alba ◽  
Medical Interventions ◽  
Enteroatmospheric Fistula ◽  
Abdominal Decompression ◽  
Abdominal Compartment ◽  
New Surgical Technique

Abdominal compartment syndrome is a cause of significant morbidity and mortality among surgical patients. It has traditionally been treated by abdominal decompression with the associated risks of chronic incisional hernia and enteroatmospheric fistula. Subcutaneous linea alba fasciotomy has recently been described as a new surgical technique for the treatment of abdominal compartment syndrome secondary to acute pancreatitis. This technique reduces intra-abdominal pressure and restores organ function while maintaining the skin and peritoneum intact for visceral protection. We describe the application of subcutaneous linea alba fasciotomy as a safe and effective alternative for the surgical management of abdominal compartment syndrome in a traumatically injured patient refractory to comprehensive medical interventions.

Linea Alba Fasciotomy: A Novel Alternative in Trauma Patients with Secondary Abdominal Compartment Syndrome

2010 ◽  
Vol 76 (3) ◽  
pp. 312-316 ◽  
Author(s):  
Juan C. Duchesne ◽  
Meghan P. Howell ◽  
Calvin Eriksen ◽  
Georgia M. Wahl ◽  
Kelly V. Rennie ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Volume Index ◽  
Trauma Patients ◽  
Linea Alba ◽  
Physiological Variables ◽  
Abdominal Hypertension ◽  
Polytrauma Patients ◽  
Abdominal Decompression ◽  
Abdominal Compartment

Polytrauma patients needing aggressive resuscitation can develop intra-abdominal hypertension (IAH) with subsequent secondary abdominal compartment syndrome (SACS). After patients fail medical therapy, decompressive laparotomy is the surgical last resort. In patients with severe pancreatitis SACS, the use of linea alba fasciotomy (LAF) is an effective intervention to lower IAH without the morbidity of laparotomy. A pilot study of LAF was designed to evaluate its benefit in patients with SACS polytrauma. We conducted an observational study of blunt injury polytrauma patients undergoing LAF. Variables measured before and after LAF included intra-abdominal pressure (IAP, mmHg), abdominal perfusion pressure (APP, mmHg), right ventricular end diastolic volume index (RVEDVI, mL/m2), and ejection fraction. Of the five trauma patients with SACS, the mean age was 36 ± 17, four (80%) male with an Injury Severity Score of 27 ± 9. Pre- and post-LAF, IAP was 20.6 ± 4.7 and 10.6 ± 2.7 ( P < 0.0001), APP 55.2 ± 5.5 and 77.6 ± 7.1 ( P < 0.0001), RVEDVI 86.4 ± 9.3 and 123.6 ± 11.9 ( P < 0.0001), and EF 27.6 ± 4.2 and 40.8 ± 5 ( P < 0.0001), respectively. One patient needed full decompression for bile ascites from unrecognized liver injury. Linea alba fasciotomy, as a first-line intervention before committing to full abdominal decompression in patients with SACS trauma, improved physiological variables without mortality Consideration for LAF as a bridge before full abdominal decompression needs further evaluation in patients with polytrauma SACS.

Subcutaneous Linea Alba Fasciotorny, Does it Really Work?

2011 ◽  
Vol 77 (1) ◽  
pp. 99-102 ◽  
Author(s):  
Ari LeppÄNiemi ◽  
Piia Hienonen ◽  
Panu Mentula ◽  
Esko Kemppainen
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Treatment Method ◽  
Abdominal Pressure ◽  
Invasive Treatment ◽  
Linea Alba ◽  
Mortality And Morbidity ◽  
Failure Assessment ◽  
The Mean ◽  
Abdominal Compartment

Subcutaneous linea alba fasciotorny (SLAF) is a minimally invasive treatment method for abdominal compartment syndrome initially used in severe acute pancreatitis (SAP). A retrospective analysis of the first 10 patients with SAP undergoing SLAF was performed to analyze the effect and outcome of this decompressive procedure. The mean age of the patients was 46 (range 33-61) years. SLAF was performed 1 to 17 days postadmission, in six cases within 48 hours. The mean (range) preoperative intra-abdominal pressure was 31 (23-45) mm Hg and immediate postoperative intra-abdominal pressure was 20 (10-33) mm Hg. The mean decrease was 10 (2-17) mm Hg and the decompressive effect was considered sufficient in six cases. A completion laparostomy within 24 hours was required in four cases. The mean preoperative Sequential Organ Failure Assessment score was 12 (4-17) and 11 (1-20) 1 to 5 days postoperatively. The decrease was five or more score points in three patients with successful SLAF. The overall mortality and morbidity rates were 4/10 and 2/10; no complications were attributed to the SLAF itself. It is concluded that SLAF is a safe decompressive technique in SAP-related abdominal compartment syndrome. The initial effect is sufficient in about half of the patients. A completion midline laparostomy is required in the nonresponders.

scholarly journals Abdominal compartment syndrome in severe acute pancreatitis (review of literature)

2020 ◽  
Vol 179 (2) ◽  
pp. 73-78
Author(s):  
L. A. Otdelnov ◽  
A. S. Mukhin
Keyword(s):  
Acute Pancreatitis ◽  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Severe Acute Pancreatitis ◽  
Medical Management ◽  
Abdominal Pressure ◽  
Decompressive Laparotomy ◽  
Russian Science Citation Index ◽  
Abdominal Hypertension ◽  
Abdominal Compartment

The study was performed for analysis of current understanding of intra-abdominal hypertension and abdominal compartment syndrome in patients with severe acute pancreatitis.The English and Russian articles about intra-abdominal hypertension and abdominal compartment syndrome in patients with severe acute pancreatitis were analyzed. The articles were found in «Russian Science Citation Index» and «PubMed».There is a pathogenetic relationship between increased intra-abdominal pressure and the development of severe acute pancreatitis.For today, it was shown that intra-abdominal hypertension in patients with severe acute pancreatitis is associated with significantly higher APACHE-II and MODS score, prevalence of pancreatic and peripancreatic tissue lesions, early infection of pancreatic necrosis and higher mortality.The article considers various variants of decompressive interventions such as decompressive laparotomy, fasciotomy and percutaneous catheter drainage. For today, there are no randomized studies devoted to researching effectiveness of different decompressive interventions.The study showed that it is necessary to regularly monitor intra-abdominal pressure in patients with severe acute pancreatitis. Patients with intra-abdominal hypertension require emergency medical management to reduce intra-abdominal pressure. Inefficiency of the medical management and development of abdominal compartment syndrome are indications for surgery. The effectiveness of different decompressive interventions requires further studies.

Pathophysiology and Management of Abdominal Compartment Syndrome

2003 ◽  
Vol 12 (4) ◽  
pp. 367-371 ◽  
Author(s):  
Jeffrey Walker ◽  
Laura M. Criddle
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Oxygen Free Radicals ◽  
Abdominal Pressure ◽  
Decompressive Laparotomy ◽  
Abdominal Hypertension ◽  
Translocation Of Bacteria ◽  
Serial Measurements ◽  
Abdominal Compartment ◽  
Multiorgan Dysfunction Syndrome

Abdominal compartment syndrome is a potentially lethal condition caused by any event that produces intra-abdominal hypertension; the most common cause is blunt abdominal trauma. Increasing intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include release of cytokines, formation of oxygen free radicals, and decreased cellular production of adenosine triphosphate. These processes may lead to translocation of bacteria from the gut and intestinal edema, predisposing patients to multiorgan dysfunction syndrome. The consequences of abdominal compartment syndrome are profound and affect many vital body systems. Hemodynamic, respiratory, renal, and neurological abnormalities are hallmarks of abdominal compartment syndrome. Medical management consists of urgent decompressive laparotomy. Nursing care involves vigilant monitoring for early detection, including serial measurements of intra-abdominal pressure.

Preformed Silastic Silos in the Management of Necrotizing Enterocolitis

2009 ◽  
Vol 75 (2) ◽  
pp. 172-174
Author(s):  
Amy B. Moore ◽  
Don K. Nakayama
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Necrotizing Enterocolitis ◽  
Clinical Status ◽  
Intestinal Resection ◽  
Multiple Organ ◽  
Clinical Syndrome ◽  
Abdominal Pressure ◽  
Definitive Surgery ◽  
Abdominal Compartment

Necrotizing enterocolitis (NEC) is sometimes complicated by abdominal compartment syndrome, a clinical syndrome characterized by multiple organ dysfunction that arises as a consequence of increased intra-abdominal pressure. The evolving clinical picture of NEC sometimes requires “second-look” operations done after initial abdominal exploration to more accurately gauge the optimal extent of surgery. Placing intestines in a preformed, spring-loaded, transparent Silastic silo, traditionally used in the staged treatment of gastroschisis, addresses both situations: decompression of the abdomen and allowing periodic inspection of the intestines. Standard silos were used in three infants with advanced (Bell Class 3) NEC without perforation before definitive surgery. Clinical indices and laboratory values were recorded during the patients’ hospital courses. All three infants had extensive areas of intestinal ischemia and necrosis. FiO2, acidosis, and urinary output remained stable or improved in two patients. Silo placement corrected abdominal compartment syndrome in the third patient. Intestinal resection was required in all infants, each achieving surgical resolution of NEC. Two patients ultimately died from respiratory and neurologic complications. Application of a silo addresses abdominal compartment syndrome as a complication of NEC and allows continual inspection of the intestines. Physiological indices may improve the patient's overall clinical status.

scholarly journals Abdominal Compartment Syndrome as a Multidisciplinary Challenge. A Literature Review

2018 ◽  
Vol 4 (4) ◽  
pp. 114-119 ◽  
Author(s):  
Gabriel Alexandru Popescu ◽  
Tivadar Bara ◽  
Paul Rad
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Treatment Guidelines ◽  
Surgical Care ◽  
Abdominal Pressure ◽  
Decompressive Laparotomy ◽  
Abdominal Hypertension ◽  
Treatment Measures ◽  
Points Of View ◽  
Abdominal Compartment

Abstract Abdominal Compartment Syndrome (ACS), despite recent advances in medical and surgical care, is a significant cause of mortality. The purpose of this review is to present the main diagnostic and therapeutic aspects from the anesthetical and surgical points of view. Intra-abdominal hypertension may be diagnosed by measuring intra-abdominal pressure and indirectly by imaging and radiological means. Early detection of ACS is a key element in the ACS therapy. Without treatment, more than 90% of cases lead to death and according with the last reports, despite all treatment measures, the mortality rate is reported as being between 25 and 75%. There are conflicting reports as to the importance of a conservative therapy approach, although such an approach is the central to treatment guidelines of the World Society of Abdominal Compartment Syndrome, Decompressive laparotomy, although a backup solution in ACS therapy, reduces mortality by 16-37%. The open abdomen management has several variants, but negative pressure wound therapy represents the gold standard of surgical treatment.

Incidence of Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: A Systematic Review

2019 ◽  
Vol 36 (2) ◽  
pp. 197-202 ◽  
Author(s):  
Zaid Khot ◽  
Patrick B. Murphy ◽  
Nathalie Sela ◽  
Neil G. Parry ◽  
Kelly Vogt ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Critically Ill ◽  
Abdominal Compartment Syndrome ◽  
Critically Ill Patients ◽  
Data Extraction ◽  
Common Finding ◽  
Abdominal Pressure ◽  
Abdominal Hypertension ◽  
Definition Of ◽  
Abdominal Compartment

Objective: To determine the contemporary prevalence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome in critically ill patients. Data Sources: Medline, Embase, and Central databases. Study Selection: Studies reporting on the prevalence of IAH in consecutively admitted critically ill patients using the World Society of Abdominal Compartment Syndrome (WSACS) consensus guidelines for intra-abdominal pressure (IAP) measurement. Data Extraction: Duplicate independent review and data abstraction. Data Synthesis: The search identified 2428 titles with 6 eligible studies (n = 1965). Reported prevalence ranged from 30% to 49%. Despite abiding by the WSACS guidelines for IAP measurement, studies varied in their definition of IAH, frequency and duration of IAP measurement, and reporting of outcomes. Three of 6 studies reported that IAH, especially at higher grades, was an independent predictor of mortality. Conclusions: Intra-abdominal hypertension is a common finding in critically ill patients and may be associated with increased mortality, especially at higher grades. Further prospective research is required to examine the effect of screening and treatment of IAH on patient outcomes.

Abdominal Compartment Syndrome in Children

2012 ◽  
Vol 32 (6) ◽  
pp. 51-61 ◽  
Author(s):  
Jennifer Newcombe ◽  
Mudit Mathur ◽  
J. Chiaka Ejike
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Care Setting ◽  
Perfusion Pressure ◽  
Abdominal Pressure ◽  
Timely Manner ◽  
Normal Ranges ◽  
Abdominal Hypertension ◽  
Abdominal Compartment ◽  
Instructive Case

Abdominal compartment syndrome is defined as sustained intra-abdominal pressure greater than 20 mm Hg (with or without abdominal perfusion pressure &lt;60 mm Hg) associated with new organ failure or dysfunction. The syndrome is associated with 90% to 100% mortality if not recognized and treated in a timely manner. Nurses are responsible for accurately measuring intra-abdominal pressure in children with abdominal compartment syndrome and for alerting physicians about important changes. This article provides relevant definitions, outlines risk factors for abdominal compartment syndrome developing in children, and discusses an instructive case involving an adolescent with abdominal compartment syndrome. Techniques for measuring intra-abdominal pressure, normal ranges, and the importance of monitoring in the critical care setting for timely identification of intra-abdominal hypertension and abdominal compartment syndrome also are discussed.

scholarly journals Acute renal failure due to abdominal compartment syndrome: report on four cases and literature review

2001 ◽  
Vol 56 (4) ◽  
pp. 123-130 ◽  
Author(s):  
Roberto de Cleva ◽  
Fabiano Pinheiro da Silva ◽  
Bruno Zilberstein ◽  
David J B Machado
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Incisional Hernia ◽  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Obese Woman ◽  
Incisional Hernia Repair ◽  
Abdominal Pressure ◽  
Urinary Flow ◽  
Abdominal Compartment

We report on 4 cases of abdominal compartment syndrome complicated by acute renal failure that were promptly reversed by different abdominal decompression methods. Case 1: A 57-year-old obese woman in the post-operative period after giant incisional hernia correction with an intra-abdominal pressure of 24 mm Hg. She was sedated and curarized, and the intra-abdominal pressure fell to 15 mm Hg. Case 2: A 73-year-old woman with acute inflammatory abdomen was undergoing exploratory laparotomy when a hypertensive pneumoperitoneum was noticed. During the surgery, enhancement of urinary output was observed. Case 3: An 18-year-old man who underwent hepatectomy and developed coagulopathy and hepatic bleeding that required abdominal packing, developed oliguria with a transvesical intra-abdominal pressure of 22 mm Hg. During reoperation, the compresses were removed with a prompt improvement in urinary flow. Case 4: A 46-year-old man with hepatic cirrhosis was admitted after incisional hernia repair with intra-abdominal pressure of 16 mm Hg. After paracentesis, the intra-abdominal pressure fell to 11 mm Hg.

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