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 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.

scholarly journals Abdominal Compartment Syndrome among Medical Patients

2021 ◽  
Author(s):  
Kejal Gandhi ◽  
Pahnwat Taweesedt ◽  
Munish Sharma ◽  
Dweep Barbhaya ◽  
Salim Surani
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Multiorgan Failure ◽  
Abdominal Pressure ◽  
Trauma Patients ◽  
Medical Patients ◽  
Diagnosis And Management ◽  
Abdominal Hypertension ◽  
Medical Intensive Care ◽  
Abdominal Compartment

Abdominal compartment syndrome and intra-abdominal hypertension (IAH) has been widely studied in surgical and trauma patients, even though the incidence of IAH in medical intensive care unit (MICU) remains high. Studies have shown that the time to decision making regarding diagnosis and management of IAH is twice in MICU compared to the corresponding surgical side. MICU patients often require large volume resuscitation such as in sepsis, hemorrhage, or an inflammatory condition such as acute pancreatitis, which increases the risk of development of IAH. It is often underdiagnosed and undertreated in MICU due to a lack of awareness of the consequences and mortality associated with it. Elevated intra-abdominal pressure has systemic effects causing atelectatic lungs, decreased cardiac output, and renal insufficiency. IAH, if not recognized early, can quickly progress to compartment syndrome causing multiorgan failure and death. Approach to ACS management between medical and surgical intensivists varies largely because of lack of experience with surgical decompression. This article provides an overview of definitions, incidence, pathophysiology, clinical presentation, diagnosis, and management of IAH and abdominal compartment syndrome in critically in medical patients.

scholarly journals Intra-abdominal Hypertension and Abdominal Compartment Syndrome in patients undergoing emergency laparotomy

2020 ◽  
Vol 24 (3) ◽  
pp. 254-259
Author(s):  
Malik Irfan Ahmed ◽  
Muhammad Waqas Raza ◽  
Fazal Hussain Shah ◽  
Muhammad Hanif ◽  
Khalid Shahzad ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Intraabdominal Pressure ◽  
Emergency Laparotomy ◽  
Trauma Patients ◽  
Burst Abdomen ◽  
Organ Systems ◽  
Abdominal Hypertension ◽  
The Impact ◽  
Abdominal Compartment

Objective: The objectives of the Prospective observational study were to identify the frequency of abdominal compartment syndrome and intraabdominal hypertension in patients undergoing emergency laparotomy for trauma and peritonitis and to determine the impact of raised intraabdominal pressure on the overall morbidity and mortality. Materials and Methods: The study was conducted in the department of surgery Benazir Bhutto Hospital Rawalpindi. From June 2013 to May 2014 a total of 50 patients undergoing emergency laparotomy were included. IAP was measured preoperatively then postoperatively at 0, 6, 24 hours, and the findings were recorded on a specially designed preform. The patients having higher IAP were further evaluated up to 72 hours. All vitals, urine output, oxygen saturation, serum urea, creatinine were noted. The main outcomes were duration of hospital stay, the occurrence of burst abdomen, and mortality. Results: At the preoperative level the incidence of IAH was 86%. The mortality association with IAH at 6 hours postoperatively was quite significant (P<0.029). The incidence of postoperative ACS was 5% among the total patients and it was 15.6% in trauma patients. No significant association was found between IAP and occurrence of burst abdomen at any level (P values 0.4, 0.26, 0.53, 0.58 at intervals preoperatively, 0, 6, 24 hours postoperative respectively.  Conclusion: Intraabdominal pressure is an important factor that predicts the mortality of patients undergoing emergency laparotomy. It should be carefully monitored and managed accordingly to avoid the detrimental effects on virtually all organ systems. Abdominal decompression in significantly elevated intraabdominal pressure reverts the physiological derangement of Intrabdominal hypertension.

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.

scholarly journals Is intraabdominal pressure a predictive factor for mortality and morbidity in abdominal trauma?

2019 ◽  
Vol 2 (1) ◽  
pp. 35-40
Author(s):  
Daniel Ion ◽  
Dan Nicolae Păduraru ◽  
Florentina Mușat ◽  
Octavian Andronic ◽  
Alexandra Bolocan
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Abdominal Trauma ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Management Plan ◽  
Intraabdominal Pressure ◽  
Mortality And Morbidity ◽  
Abdominal Hypertension ◽  
Abdominal Compartment

AbstractThe clinical signs and symptoms of an acute in increase intraabdominal pressure (IAP) are subtle, especially in the conditions of the polytraumatized patient. Thus, abdominal compartment syndrome (ACS) can brutally occur and can have a major impact on the body’s main organs and systems. The purpose of our research was to identify the influence of intraabdominal pressure, intra-abdominal hypertension, and abdominal compartment syndrome, in the evolution of polytraumatized patients. Our study analyzed the patients admitted in the IIIrd Department of General Surgery of University Emergency Hospital in Bucharest between 1st of January 2010 and 31st of December 2018. The value of intraabdominal pressure, on admission, correlated with the risk of IAH/ ACS in patients with abdominal trauma - being major causes of morbidity and mortality. IAP monitoring should become a mandatory part of the management plan for patients with abdominal trauma.

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.

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