Decompressive laparotomy for abdominal compartment syndrome in patient on extracorporeal life support: A first survival case among adults with literature review

Here, we report a case of successful treatment for a patient with abdominal compartment syndrome who was on venoarterial extracorporeal life support. A 33-year-old man visited the emergency room with cardiac arrest. Extracorporeal cardiopulmonary resuscitation was performed, and massive volume infusion was needed to maintain adequate perfusion pressure. After 6 h, his abdomen was distended, and venous drain was decreased. His bladder pressure was more than 25 mm Hg. Abdominal compartment syndrome was suspected, and prompt decompressive laparotomy was performed to restore venous drain, resulting in stabilization hemodynamically. The patient made a full recovery. He was discharged after implantation of internal cardiac defibrillator.

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Management of abdominal compartment syndrome during extracorporeal life support

Pediatric Critical Care Medicine ◽

10.1097/01.pcc.0000257102.53488.5e ◽

2007 ◽

Vol 8 (2) ◽

pp. 177-179 ◽

Cited By ~ 21

Author(s):

Regina Okhuysen-Cawley ◽

Parthak Prodhan ◽

Michiaki Imamura ◽

A Heather Dedman ◽

K J. S. Anand

Keyword(s):

Compartment Syndrome ◽

Abdominal Compartment Syndrome ◽

Life Support ◽

Extracorporeal Life Support ◽

Abdominal Compartment

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The Abdomen in “Thoracoabdominal” Cannot Be Ignored: Abdominal Compartment Syndrome Complicating Extracorporeal Life Support

Case Reports in Critical Care ◽

10.1155/2014/351340 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Arthur J. Lee ◽

Bryan J. Wells ◽

Rosaleen Chun ◽

Chad G. Ball ◽

Andrew. W. Kirkpatrick

Keyword(s):

Compartment Syndrome ◽

Critically Ill ◽

Abdominal Compartment Syndrome ◽

Life Support ◽

Extracorporeal Life Support ◽

Young Male ◽

Care Providers ◽

Anoxic Injury ◽

Life Saving ◽

Abdominal Compartment

Extracorporeal life support (ECLS) is an incredible life-saving measure that is being used ever more frequently in the care of the critically ill. Management of these patients requires extreme vigilance on the part of the care providers in recognizing and addressing the complications and challenges that may arise. We present a case of overt abdominal compartment syndrome (ACS) in a previously well young male on ECLS with a history of trauma, submersion, hypothermia, and no intra-abdominal injuries. The patient developed ACS soon after ECLS was initiated which resulted in drastically compromised flow rates. Taking into account the patient’s critical status, an emergent laparotomy was performed in the intensive care unit which successfully resolved the ACS and restored ECLS flow. The patient had an unremarkable course following and was weaned off ECLS but unfortunately died from his original anoxic injury. This case highlights several salient points: first, care of patients on ECLS is challenging and multiple etiologies can affect our ability to manage these patients; second, intra-abdominal pressures should be monitored liberally in the critically ill, especially in patients on ECLS; third, protocols for emergent operative treatment outside of traditional operating rooms should be established and care providers should be prepared for these situations.

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Abdominal Compartment Syndrome Complicating Paediatric Extracorporeal Life Support: Diagnostic and Therapeutic Challenges

Anaesthesia and Intensive Care ◽

10.1177/0310057x0803600517 ◽

2008 ◽

Vol 36 (5) ◽

pp. 726-731 ◽

Cited By ~ 15

Author(s):

M. C. W. Lam ◽

P. T. Yang ◽

P. W. Skippen ◽

N. Kissoon ◽

E. D. Skarsgard

Keyword(s):

Compartment Syndrome ◽

Abdominal Compartment Syndrome ◽

Life Support ◽

Extracorporeal Life Support ◽

Abdominal Compartment

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Paracentesis for Resuscitation-Induced Abdominal Compartment Syndrome: An Alternative to Decompressive Laparotomy in the Burn Patient

Journal of Trauma and Acute Care Surgery ◽

10.1097/01.ta.0000217274.48792.4d ◽

2006 ◽

Vol 60 (5) ◽

pp. 1119-1121 ◽

Cited By ~ 41

Author(s):

Michael W. Parra ◽

Haitham Al-Khayat ◽

Howard G. Smith ◽

Michael L. Cheatham

Keyword(s):

Compartment Syndrome ◽

Abdominal Compartment Syndrome ◽

Decompressive Laparotomy ◽

Abdominal Compartment ◽

Burn Patient

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

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2020-179-2-73-78 ◽

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.

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Decompressive Abdominal Laparotomy for Abdominal Compartment Syndrome in an Unengrafted Bone Marrow Recipient with Septic Shock

Critical Care Research and Practice ◽

10.1155/2010/102910 ◽

2010 ◽

Vol 2010 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Derrick J. N. Dauplaise ◽

Sean J. Barnett ◽

Jason S. Frischer ◽

Hector R. Wong

Keyword(s):

Bone Marrow ◽

Septic Shock ◽

Compartment Syndrome ◽

Abdominal Compartment Syndrome ◽

Pediatric Intensive Care ◽

Individual Case ◽

Individual Case Report ◽

Decompressive Laparotomy ◽

Massive Fluid ◽

Abdominal Compartment

Objective. To describe a profoundly immunocompromised (panleukopenia) child with septic shock who developed abdominal compartment syndrome (ACS) and was successfully treated with surgical decompression.Design. Individual case report.Setting. Pediatric intensive care unit of a tertiary children's hospital.Patient. A 32-month-old male with Fanconi anemia who underwent bone marrow transplantation (BMT) 5 days prior to developing septic shock secondary toStreptococcus viridansandEscherichia coliACS developed after massive fluid resuscitation, leading to cardiopulmonary instability.Interventions. Emergent surgical bedside laparotomy and silo placement.Measurements and Main Results. The patient's cardiopulmonary status stabilized after decompressive laparotomy. The abdomen was closed and the patient survived to hospital discharge without cardiac, respiratory, or renal dysfunction.Conclusions. The use of laparotomy and silo placement in an unengrafted BMT patient with ACS and septic shock did not result in additional complications. Surgical intervention for ACS is a reasonable option for high risk, profoundly immunocompromised patients.

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Pathophysiology and Management of Abdominal Compartment Syndrome

American Journal of Critical Care ◽

10.4037/ajcc2003.12.4.367 ◽

2003 ◽

Vol 12 (4) ◽

pp. 367-371 ◽

Cited By ~ 50

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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Abdominal Compartment Syndrome as a Multidisciplinary Challenge. A Literature Review

The Journal of Critical Care Medicine ◽

10.2478/jccm-2018-0024 ◽

2018 ◽

Vol 4 (4) ◽

pp. 114-119 ◽

Cited By ~ 6

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.

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Abdominal Compartment Syndrome in Children

Critical Care Nurse ◽

10.4037/ccn2012761 ◽

2012 ◽

Vol 32 (6) ◽

pp. 51-61 ◽

Cited By ~ 18

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 <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.

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