World Journal of Surgery

, Volume 32, Issue 8, pp 1851–1856 | Cite as

Early Elevation of Intra-Abdominal Pressure After Laparotomy for Secondary Peritonitis: A Predictor of Relaparotomy?

  • Adhish BasuEmail author
  • Dinker R. Pai



Patients with secondary peritonitis often require relaparotomy; however, there is no consensus about the criteria for selecting patients who would benefit from early relaparotomy. Our goal was to evaluate whether elevated intra-abdominal pressure (IAP) during the early postoperative period could predict the need for relaparotomy.


A total of 102 consecutive adult patients with acute intra-abdominal conditions were admitted for laparotomy. Seventy-eight patients, who were diagnosed with secondary peritonitis at index surgery, underwent serial measurements of IAP. The primary outcomes measured in the study were incidence of postoperative peritonitis and mortality.


Thirty-two of 78 patients with secondary peritonitis (41%) developed elevated IAP postoperatively. Sixteen (20.5%) of 78 patients developed postoperative peritonitis. Twelve of these 16 patients (75%) with postoperative peritonitis had significantly elevated IAP (P = 0.002) during the immediate postoperative period. Regression analysis revealed elevated IAP (P = 0.055) to be third most predictive of postoperative peritonitis in patients who underwent laparotomy for secondary peritonitis, after septic shock at admission (P = 0.012) and POSSUM score (P = 0.018).


Our study shows that development of elevated IAP during the early postoperative period can increase the risk of postoperative peritonitis. IAP measured during the immediate postoperative period can be used as a predictor of early relaparotomy.


Peritonitis Abdominal Compartment Syndrome Secondary Peritonitis Systemic Sepsis Primary Fascial Closure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    van Ruler O, Mahler CW, Boer KR, Reuland EA, Gooszen HG, Opmeer BC, de Graaf PW, Lamme B, Gerhards MF, Steller EP, van Till JW, de Borgie CJ, Gouma DJ, Reitsma JB, Boermeester MA; Dutch Peritonitis Study Group (2007) Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis. JAMA 298:865–872PubMedCrossRefGoogle Scholar
  2. 2.
    Koperna T, Schulz F (1996) Prognosis and treatment of peritonitis. Do we need new scoring systems? Arch Surg 131:180–186PubMedGoogle Scholar
  3. 3.
    Paugam-Burtz C, Dupont H, Marmuse JP, Chosidow D, Malek L, Desmonts JM, Mantz J (2002) Daily organ-system failure for diagnosis of persistent intra-abdominal sepsis after postoperative peritonitis. Intensive Care Med 28:594–598PubMedCrossRefGoogle Scholar
  4. 4.
    Plantefeve G, Hellmann R, Pajot O, Thirion M, Bleichner G, Mentec H (2007) Abdominal compartment syndrome and intraabdominal sepsis: two of the same kind? Acta Clinica Belgica 62(Suppl 1):162–167Google Scholar
  5. 5.
    Diebel LN, Dulchavsky SA, Wilson RF (1992) Effect of increased intra-abdominal pressure on mesenteric arterial and intestinal mucosal blood flow. J Trauma 33:45–49PubMedCrossRefGoogle Scholar
  6. 6.
    Polat C, Arikan Y, Vatansev C et al (2002) The effects of increased intraabdominal pressure on colonic anastomosis. Surg Endosc 16:1314–1319PubMedCrossRefGoogle Scholar
  7. 7.
    Diebel LN, Saxe J, Dulchavsky S (1992) Effect of intra-abdominal pressure on abdominal wall blood flow. Am Surg 58:573–576PubMedGoogle Scholar
  8. 8.
    Hong JJ, Cohn SM, Perez JM, Dolich MO, Brown M, McKenney MG (2002) Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 89:591–596PubMedCrossRefGoogle Scholar
  9. 9.
    Balogh Z, McKinley BA, Holcomb JB et al (2003) Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Trauma 54:848–861PubMedCrossRefGoogle Scholar
  10. 10.
    Malbrain MLNG (1999) Abdominal pressure in the critically ill: measurement and clinical relevance. Intensive Care Med 25:1453–1458PubMedCrossRefGoogle Scholar
  11. 11.
    Sugrue M, Buist MD, Hourihan F, Deane S, Bauman A, Hillman K (1995) Prospective study of intra-abdominal hypertension and renal function after laparotomy. Br J Surg 82:235–238PubMedCrossRefGoogle Scholar
  12. 12.
    Rakiæ M, Popoviæ D, Rakiæ M, Druijaniæ N, Lojpur M, Hall BA, Williams BA, Sprung J (2005) Comparison of on-demand vs planned relaparotomy for treatment of severe intra-abdominal infections. Croat Med J 46:957–963Google Scholar
  13. 13.
    Pai D, Sharma A, Kanungo R, Jagdish S, Gupta A (1999) Role of abdominal drains in perforated duodenal ulcer patients: a prospective controlled study. Aust N Z J Surg 69:210–213PubMedCrossRefGoogle Scholar
  14. 14.
    Nair A, Pai DR, Jagdish S (2006) Predicting anastomotic disruption after emergent small bowel surgery. Dig Surg 23:38–43PubMedCrossRefGoogle Scholar
  15. 15.
    Basu A (2007) A low-cost technique for measuring the intra-abdominal pressure in the non-industrialized countries. Ann R Coll Surg Engl 89:434–435PubMedGoogle Scholar
  16. 16.
    Malbrain ML, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J et al (2006) Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med 32:1722–1732. Epub 12 Sep 2006PubMedCrossRefGoogle Scholar
  17. 17.
    Copeland GP (2002) The POSSUM system of surgical audit. Arch Surg 137:15–19PubMedCrossRefGoogle Scholar
  18. 18.
    Boermeester MA (2007) Surgical approaches to peritonitis. Br J Surg 94:1317–1318PubMedCrossRefGoogle Scholar
  19. 19.
    Mcnelis J, Soffer S, Marini CP et al (2002) Abdominal compartment syndrome in the surgical intensive care unit. Am Surg 68:18–23PubMedGoogle Scholar
  20. 20.
    Moore AFK, Hargest R, Martin M, Delicata RJ (2004) Intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 91:1102–1110PubMedCrossRefGoogle Scholar
  21. 21.
    Gracias VH, Braslow B, Johnson J, Pryor J, Gupta R, Reilly P et al (2003) Abdominal compartment syndrome in the open abdomen. Arch Surg 138:703–706CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  1. 1.Department of SurgeryJawaharlal Institute of Postgraduate Medical Education and ResearchPondicherryIndia
  2. 2.Department of SurgeryPondicherry Institute of Medical SciencesKalapetPondicherryIndia
  3. 3.Department of SurgeryProvidence Hospital and Medical CentersSouthfieldUSA
  4. 4.Asian Institute of Medicine, Science and TechnologySungai PetaniMalaysia

Personalised recommendations