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Abdominal Compartment Syndrome and Open Abdomen Treatment

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Mechanisms of Vascular Disease

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Abstract

Intra-abdominal hypertension (IAH) threatens the function of most vital organs. When the intra-abdominal pressure reaches 20 mmHg, and new organ dysfunction or failure develops, an abdominal compartment syndrome (ACS) has developed. This complication is common after aortic surgery, in particular after surgery for a ruptured abdominal aortic aneurysm. It may also develop after trauma, intra-abdominal bleeding or mesenteric ischaemia. When ACS develops, mortality is high, around 50%, irrespective of the mode of the original operation, or the mechanism of IAH. In this chapter, the pathogenesis and preventive measures are discussed. Permissive hypotension during the preoperative phase, early recognition and proactive medical treatment, can all prevent ACS. Even with active prevention, however, treatment with open abdomen may sometimes be necessary. Treating a patient with open abdomen is a major challenge, and then dedication to surgical detail is a key factor for success.

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Further Reading

  • Acosta S, Seternes A, Venermo M, Vikatmaa L, Sörelius K, Wanhainen A, Svensson M, Djavani K, Björck M. Open abdomen therapy with vacuum and mesh-mediated fascial traction after aortic repair—an international multi-centre study. Eur J Vasc Endovasc Surg. 2017;54:697–705.

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  • Björck M, Bruhin A, Cheatham M, Hinck D, Kaplan M, Manca G, Wild T, Windsor A. Classification, an important step to improve the management of patients with an open abdomen. World J Surg. 2009;33:1154–7.

    PubMed  Google Scholar 

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    CAS  PubMed  Google Scholar 

  • Ersryd S, Djavani Gidlund K, Wanhainen A, Smith L, Björck M. Abdominal compartment syndrome after surgery for abdominal aortic aneurysm: subgroups, risk factors and outcome. Eur J Vasc Endovasc Surg. 2019;58(5):671–9.

    PubMed  Google Scholar 

  • Kirkpatrick A, Roberts DJ, De Waele J, Jaeschke R, Malbrain MLNG, De Kuelenaer B, Duchesne J, Björck M, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39:1190–206.

    PubMed  PubMed Central  Google Scholar 

  • Mell MW, O’Neil AS, Callcut RA, Acher CW, Hoch JR, Tefera G, Turnipseed WD. Effect of early plasma transfusion on mortality in patients with ruptured abdominal aortic aneurysm. Surgery. 2010;148:955–62.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden

    Martin Björck

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  1. Martin Björck
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Correspondence to Martin Björck .

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Editors and Affiliations

  1. Discipline of Surgery, The University of Adelaide, Adelaide, SA, Australia

    Robert Fitridge

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Björck, M. (2020). Abdominal Compartment Syndrome and Open Abdomen Treatment. In: Fitridge, R. (eds) Mechanisms of Vascular Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-43683-4_19

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  • DOI: https://doi.org/10.1007/978-3-030-43683-4_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-43682-7

  • Online ISBN: 978-3-030-43683-4

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