Infection

, Volume 27, Issue 1, pp 61–66

Multisystem organ failure secondary to increased intraabdominal pressure

  • H. J. Sugerman
  • G. L. Bloomfield
  • B. W. Saggi
Special Addendum-Part II Infections in Intraabdominal Surgery

Summary

Acutely increased intraabdominal pressure can lead to multisystem organ dysfunction. Organ dysfunction consists of acute pulmonary failure secondary to compressive atelectasis and associated with high peak inspiratory pressures and impaired gas exchange, acute renal failure with marked oliguria without hypernaturia, intestinal and hepatic ischemia possibly leading to bacterial translocation or necrosis with peritonitis, increased intracranial pressures which may cause brain dysfunction or aggravate head injury edema, venous thrombosis and thromboembolism, and abdominal wall ischemia or necrosis. The diagnosis is made clinically in a patient with high peak inspiratory pressures, oliguria and an apparently tight abdomen, although urinary bladder pressure ≥ 20 cm H2O pressure is suggestive. However, chronically increased intraabdominal pressure as is seen in the morbidly pregnancy and cirrhosis may be misleading. As to treatment, once the diagnosis is made, the patient's abdomen should be opened and the tension relieved. The intestinal contents need to be protected and evaporative water loss minimized by either closing the skin and not the fascia or, if this is not possible, using an impermeable protective dressing. If the abdomen is difficult to close at the primary operation, it is best to prevent the development of an acute abdominal compartment syndrome by closing only the skin or leaving it open and using an impermeable dressing. In conclusion, the acute abdominal compartment syndrome has become increasingly recognized as a cause for multisystem organ failure. Recognition of the problem or prevention is mandatory for optimal patient survival.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Harman, P. K., Kron, I. L., McLachlan, H. D., Freedlander, A. E., Nolan, S. P.: Elevated intra-abdominal pressure and renal function. Ann. Surg. 196 (1982) 594–597.PubMedCrossRefGoogle Scholar
  2. 2.
    Richardson, J. D., Trinkle, J. K.: Hemodynamic and respiratory alterations with increased intra-abdominal pressure. J. Surg. Res. 20 (1976) 401–404.PubMedCrossRefGoogle Scholar
  3. 3.
    Fietsam, R. Jr., Villalba, M., Glover, J. L., Clark, K.: Intra-abdominal compartment syndrome as a complication of ruptured abdominal aortic aneurysm repair. Am. J. Surg. 55 (1989) 396–402.Google Scholar
  4. 4.
    Platell, C. F., Hall, J., Clarke, G., Lawrence-Brown, M.: Intra-abdominal pressure and renal function after surgery to the abdominal aorta. Aust. N Z J. Surg. 60 (1990) 213–216.PubMedGoogle Scholar
  5. 5.
    Richards, W. O., Scovill, W., Shin, B., Reed, W.: Acute renal failure associated with increased intra-abdominal pressure. Ann. Surg. 197 (1983) 183–187.PubMedGoogle Scholar
  6. 6.
    Bloomfield, G. L., Blocher, C. R., Fakhry, I. F., Sica, D. A., Sugerman, H. J.: Elevated intra-abdominal pressure increases plasma renin activity and aldosterone levels. J. Trauma 42 (1997) 997–1005.PubMedGoogle Scholar
  7. 7.
    Cullen, D. J., Coyle, J. P., Teplick, R., Long, M. C.: Cardiovascular, pulmonary, and renal effects of massively increased intra-abdominal pressure in critically ill patients. Crit. Care Med. 17 (1989) 118–121.PubMedCrossRefGoogle Scholar
  8. 8.
    Mutoh, T., Lamm, J. E., Embree, L. J., Hildebrandt, J., Albert, R. K.: Abdominal distension alters regional pleural pressures and chest wall mechanics in pigsin vivo. J. Appl. Physiol. 70 (1991) 2611–2618.PubMedGoogle Scholar
  9. 9.
    Smith, J. H., Merrell, R. C., Raffin, T. A.: Reversal of postoperative anuria by decompressive celiotomy. Arch. Intern. Med. 145 (1985) 553–554.PubMedCrossRefGoogle Scholar
  10. 10.
    Diament, L., Benumof, J. L., Saidman, L. J.: Hemodynamics of increased intra-abdominal pressure. Anesthesiology 48 (1978) 23–26.CrossRefGoogle Scholar
  11. 11.
    Kashtan, J., Green, J. F., Parsons, E. Q., Holcroft, J. W.: Hemodynamic effects of increased abdominal pressure. J. Surg. Res. 30 (1981) 249–255.PubMedCrossRefGoogle Scholar
  12. 12.
    Ridings, P. C., Bloomfield, G. L., Blocher, C. R., Sugerman, H. J.: Cardiopulmonary effects of raised intra-abdominal pressure before and after volume expansion. J. Trauma 39 (1995) 1071–1075.PubMedGoogle Scholar
  13. 13.
    Shelley, M. P., Robinson, A. A., Hesforf, J. W.: Hemodynamic effects following surgical release of increased intra-abdominal pressure. J. Surg. Res. 59 (1981) 800–805.Google Scholar
  14. 14.
    Meldrum, D. R., Moore, F. A., Moore, E. E., Haenel, J. B., Cosgriff, N., Burch, J. M.: Cardiopulmonary hazards of perihepatic packing for major liver injuries. Am. J. Surg. 170 (1995) 537–540.PubMedCrossRefGoogle Scholar
  15. 15.
    Bloomfield, G. L., Ridings, P. C., Blocher, C. S., Marmarou, A., Sugerman, H. J.: Effects of increased intra-abdominal pressure upon intracranial and cerebral perfusion pressure before and after volume expansion. J. Trauma 40 (1996) 936–943.PubMedCrossRefGoogle Scholar
  16. 16.
    Mijangos, J. L., Thwin, N., Hinchey, E. J.: Changes in intracranial pressure during carbon dioxide pneumoperitoneum in normovolemic and hypovolemic animals. Surg. Forum 45 (1994) 583–586.Google Scholar
  17. 17.
    Bloomfield, G. L., Ridings, P. C., Blocher, C. R., Marmarou, A., Sugerman, H. J.: A proposed relationship between increased intra-abdominal pressure, intrathoracic, and intracranial pressure. Crit. Care Med. 25 (1997) 496–503.PubMedCrossRefGoogle Scholar
  18. 18.
    Josephs, L. G., Este-McDonald, J. R., Birkett, D. H., Hirsch, E. F.: Diagnostic laparoscopy increases intracranial pressure. J. Trauma 36 (1994) 815–819.PubMedGoogle Scholar
  19. 19.
    Irgau, I., Koyfman, Y., Tikellis, J. I.: Elective intraoperative intracranial pressure monitoring during laparoscopic cholecystectomy. Arch. Surg. 130 (1995) 1101–1103.Google Scholar
  20. 20.
    Bloomfield, G. L., Dalton, J. M., Sugerman, H. J., Ridings, P. C., DeMaria, E. J., Bullock, R.: Treatment of increasing intracranial pressure secondary to the acute abdominal compartment syndrome in a patient with combined abdominal and head trauma. J. Trauma 30 (1995) 1168–1170.Google Scholar
  21. 21.
    Diebel, L. N., Wilson, R. F., Dulchavsky, S. A., Saxe, J.: Effect of increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J. Trauma 33 (1992) 279–282.PubMedGoogle Scholar
  22. 22.
    Diebel, L. N., Dulchavsky, S. A., Wilson, R. F.: Effect of increased intra-abdominal pressure on mesenteric arterial and intestinal blood flow. J. Trauma 33 (1992) 45–49.PubMedGoogle Scholar
  23. 23.
    Diebel, L., Saxe, J., Dulchavsky, S.: Effect of intra-abdominal pressure on abdominal wall blood flow. Ann. Surg. 58 (1992) 573–575.Google Scholar
  24. 24.
    Iberti, T. J., Kelly, K. M., Gentili, D. R., Hirsch, S., Benjamin, E.: A simple technique to accurately determine intra-abdominal pressure. Crit. Care Med. 15 (1987) 1140–1142.PubMedGoogle Scholar
  25. 25.
    Lacey, S. R., Bruce, J., Brooks, S. P., Griswald, J., Ferguson, W., Allen, J. E., Jewett, T. C., Jr., Karp, M. P., Cooney, D. R.: The relative merits of various methods of indirect measurement of intra-abdominal pressure as a guide to closure of abdominal wall defects. J. Pediatr. Surg. 22 (1987) 1207–1211.PubMedGoogle Scholar
  26. 26.
    Sugerman, H., Windsor, A., Bessos, M., Wolfe, L.: Intra-abdominal pressure, sagittal abdominal diameter and obesity comorbidity. J. Int. Med. 241 (1997) 71–79.CrossRefGoogle Scholar
  27. 27.
    Hirshberg, A., Wall, M. J. Jr., Mattox, K. L.: Planned reoperation for trauma: a two year experience with 124 consecutive patients. J. Trauma 37 (1994) 365–369.PubMedGoogle Scholar
  28. 28.
    Wittmann, D. H., Aprahamian, C., Bergstein, J. M.: Etappenlavage: advanced diffuse peritonitis managed by planned multiple laparotomies utilizing zippers, slide fasteners, and Velcro analogue for temporary abdominal closure. World J. Surg. 14 (1990) 218–226.PubMedCrossRefGoogle Scholar
  29. 29.
    Wittmann, D. H., Aprahamian, C., Bergstein, J. M., Edmiston, C. E., Frantzides, C. T., Quebbeman, E. J., Condon, R. E.: A burr-like device to facilitate temporary abdominal closure in planned multiple laparotomies. Eur. J. Surg. 159 (1993) 75–79.PubMedGoogle Scholar
  30. 30.
    Rotondo, M. F., Schwab, C. W., McGonigal, M. D., Phillips, G. R. 3d, Fruchterman, T. M., Kauder, D. R., Latenser, B. A., Angood, P. A.: “Damage Control”: an approach for improved survival in exsanguinating penetrating abdominal injury. J. Trauma 35 (1993) 375–382.PubMedCrossRefGoogle Scholar
  31. 31.
    Schein, M., Wittman, D. H., Aprahamian, C. C., Condon, R. E.: The abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure. J. Am. Coll. Surg. 180 (1995) 745–753.PubMedGoogle Scholar
  32. 32.
    Fabian, T. C., Croce, M. A., Pritchard, F. E., Minard, G., Hickerson, W. L., Howell, R. L., Schurr, M. J., Kudsk, K. A.: Planned ventral hernia. Staged management for acute abdominal wall defects. Ann. Surg. 219 (1994) 643–650.PubMedCrossRefGoogle Scholar
  33. 33.
    Morris, J. A. Jr., Eddy, V. A., Blinman, T. A., Rutherford, E. J., Sharp, K. W.: The staged celiotomy for trauma. Issues in unpacking and reconstruction. Ann. Surg. 217 (1993) 576–584.PubMedCrossRefGoogle Scholar

Copyright information

© MMV Medien & Medizin VerlagsGmbH 1999

Authors and Affiliations

  • H. J. Sugerman
    • 1
  • G. L. Bloomfield
    • 1
  • B. W. Saggi
    • 1
  1. 1.General Surgery/Trauma Div., Dept. of Surgery, Medical College of VirginiaVirginia Commonwealth UniversityUSA

Personalised recommendations