Abdominal Compartment Hypertension and Abdominal Compartment Syndrome

  • Patrick Maluso
  • Babak SaraniEmail author


Abdominal hypertension and compartment syndrome are frequent events following large-volume fluid resuscitation, complex ventral herniorrhaphy, pancreatitis, and other common disorders in the ICU. Early signs and symptoms heralding IAH and ACS lack sensitivity, and a high index of suspicion is needed to diagnose these problems early. Failure to recognize ACS, in particular, is associated with increased mortality related to multisystem organ failure. Whereas abdominal decompression remains the gold standard of treatment, other nonoperative treatment options, such as paracentesis and pharmacologic paralysis, can be used in selected instances. When a decompressive laparotomy is performed, timely closure of the abdominal wall is essential to minimize risk of development of an entero-atmospheric fistula and loss of domain ventral hernia.


Abdominal compartment syndrome Abdominal hypertension Decompressive laparotomy Open abdomen 


  1. 1.
    Balogh Z, McKinley BA, Cocanour CS, et al. Secondary abdominal compartment syndrome is an elusive early complication of traumatic shock resuscitation. Am J Surg. 2002;184:538–43; discussion 43–4.CrossRefGoogle Scholar
  2. 2.
    Balogh Z, McKinley BA, Holcomb JB, et al. Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Trauma. 2003;54:848–59; discussion 59–61.CrossRefGoogle Scholar
  3. 3.
    Department of Surgical Education. Intraabdominal pressure monitoring. In: Orlando; 2008. Available at: Accessed 11/20/2015.Google Scholar
  4. 4.
    Vidal MG, Ruiz Weisser J, Gonzalez F, et al. Incidence and clinical effects of intra-abdominal hypertension in critically ill patients. Crit Care Med. 2008;36:1823–31.CrossRefGoogle Scholar
  5. 5.
    Kirkpatrick AW, Roberts DJ, De Waele J, 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.CrossRefGoogle Scholar
  6. 6.
    Sanchez NC, Tenofsky PL, Dort JM, Shen LY, Helmer SD, Smith RS. What is normal intra-abdominal pressure? Am Surg. 2001;67:243–8.PubMedGoogle Scholar
  7. 7.
    Hering R, Wrigge H, Vorwerk R, et al. The effects of prone positioning on intra-abdominal pressure and cardiovascular and renal function in patients with acute lung injury. Anesth Analg. 2001;92:1226–31.CrossRefGoogle Scholar
  8. 8.
    Wilson A, Longhi J, Goldman C, McNatt S. Intra-abdominal pressure and the morbidly obese patients: the effect of body mass index. J Trauma. 2010;69:78–83.CrossRefGoogle Scholar
  9. 9.
    Madigan MC, Kemp CD, Johnson JC, Cotton BA. Secondary abdominal compartment syndrome after severe extremity injury: are early, aggressive fluid resuscitation strategies to blame? J Trauma. 2008;64:280–5.CrossRefGoogle Scholar
  10. 10.
    Regueira T, Bruhn A, Hasbun P, et al. Intra-abdominal hypertension: incidence and association with organ dysfunction during early septic shock. J Crit Care. 2008;23:461–7.CrossRefGoogle Scholar
  11. 11.
    Reintam Blaser A, Parm P, Kitus R, Starkopf J. Risk factors for intra-abdominal hypertension in mechanically ventilated patients. Acta Anaesthesiol Scand. 2011;55:607–14.CrossRefGoogle Scholar
  12. 12.
    Reintam Blaser A, Parm P, Kitus R, Starkopf J. Intra-abdominal hypertension and gastrointestinal symptoms in mechanically ventilated patients. Crit Care Res Pract. 2011;2011:982507.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Kasotakis G, Duggan M, Li Y, et al. Optimal pressure of abdominal gas insufflation for bleeding control in a severe swine splenic injury model. J Surg Res. 2013;184:931–6.CrossRefGoogle Scholar
  14. 14.
    Neal MD, Hoffman MK, Cuschieri J, et al. Crystalloid to packed red blood cell transfusion ratio in the massively transfused patient: when a little goes a long way. J Trauma Acute Care Surg. 2012;72:892–8.CrossRefGoogle Scholar
  15. 15.
    Holodinsky JK, Roberts DJ, Ball CG, et al. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome among adult intensive care unit patients: a systematic review and meta-analysis. Crit Care. 2013;17:R249.CrossRefGoogle Scholar
  16. 16.
    Cheatham ML, Malbrain ML, Kirkpatrick A, et al. Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome. II. Recommendations. Intensive Care Med. 2007;33:951–62.CrossRefGoogle Scholar
  17. 17.
    Obeid F, Saba A, Fath J, et al. Increases in intra-abdominal pressure affect pulmonary compliance. Arch Surg. 1995;130:544–7; discussion 7–8.CrossRefGoogle Scholar
  18. 18.
    Pelosi P, Quintel M, Malbrain ML. Effect of intra-abdominal pressure on respiratory mechanics. Acta Clin Belg. 2007;62 Suppl 1:78–88.CrossRefGoogle Scholar
  19. 19.
    Gattinoni L, Pelosi P, Suter PM, Pedoto A, Vercesi P, Lissoni A. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med. 1998;158:3–11.CrossRefGoogle Scholar
  20. 20.
    Cullen DJ, Coyle JP, Teplick R, Long MC. Cardiovascular, pulmonary, and renal effects of massively increased intra-abdominal pressure in critically ill patients. Crit Care Med. 1989;17:118–21.CrossRefGoogle Scholar
  21. 21.
    Ridings PC, Bloomfield GL, Blocher CR, Sugerman HJ. Cardiopulmonary effects of raised intra-abdominal pressure before and after intravascular volume expansion. J Trauma. 1995;39:1071–5.CrossRefGoogle Scholar
  22. 22.
    Barnes GE, Laine GA, Giam PY, Smith EE, Granger HJ. Cardiovascular responses to elevation of intra-abdominal hydrostatic pressure. Am J Physiol. 1985;248:R208–13.PubMedGoogle Scholar
  23. 23.
    Harman PK, Kron IL, McLachlan HD, Freedlender AE, Nolan SP. Elevated intra-abdominal pressure and renal function. Ann Surg. 1982;196:594–7.CrossRefGoogle Scholar
  24. 24.
    Sugrue M, Jones F, Deane SA, Bishop G, Bauman A, Hillman K. Intra-abdominal hypertension is an independent cause of postoperative renal impairment. Arch Surg. 1999;134:1082–5.CrossRefGoogle Scholar
  25. 25.
    Bradley SE, Bradley GP. The effect of increased intra-abdominal pressure on renal function in man. J Clin Invest. 1947;26:1010–22.CrossRefGoogle Scholar
  26. 26.
    Bloomfield GL, Blocher CR, Fakhry IF, Sica DA, Sugerman HJ. Elevated intra-abdominal pressure increases plasma renin activity and aldosterone levels. J Trauma. 1997;42:997–1004; discussion –5.CrossRefGoogle Scholar
  27. 27.
    Diebel LN, Wilson RF, Dulchavsky SA, Saxe J. Effect of increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J Trauma. 1992;33:279–82; discussion 82–3.CrossRefGoogle Scholar
  28. 28.
    Burchard KW, Ciombor DM, McLeod MK, Slothman GJ, Gann DS. Positive end expiratory pressure with increased intra-abdominal pressure. Surg Gynecol Obstet. 1985;161:313–8.PubMedGoogle Scholar
  29. 29.
    Diebel LN, Dulchavsky SA, Wilson RF. Effect of increased intra-abdominal pressure on mesenteric arterial and intestinal mucosal blood flow. J Trauma. 1992;33:45–8; discussion 8–9.CrossRefGoogle Scholar
  30. 30.
    Bongard F, Pianim N, Dubecz S, Klein SR. Adverse consequences of increased intra-abdominal pressure on bowel tissue oxygen. J Trauma. 1995;39:519–24; discussion 24–5.CrossRefGoogle Scholar
  31. 31.
    Diebel LN, Dulchavsky SA, Brown WJ. Splanchnic ischemia and bacterial translocation in the abdominal compartment syndrome. J Trauma. 1997;43:852–5.CrossRefGoogle Scholar
  32. 32.
    Sugrue M, Bauman A, Jones F, et al. Clinical examination is an inaccurate predictor of intra-abdominal pressure. World J Surg. 2002;26:1428–31.CrossRefGoogle Scholar
  33. 33.
    Malbrain ML, Deeren DH. Effect of bladder volume on measured intravesical pressure: a prospective cohort study. Crit Care. 2006;10:R98.CrossRefGoogle Scholar
  34. 34.
    Lee SL, Anderson JT, Kraut EJ, Wisner DH, Wolfe BM. A simplified approach to the diagnosis of elevated intra-abdominal pressure. J Trauma. 2002;52:1169–72.CrossRefGoogle Scholar
  35. 35.
    Sugrue M, Buist MD, Lee A, Sanchez DJ, Hillman KM. Intra-abdominal pressure measurement using a modified nasogastric tube: description and validation of a new technique. Intensive Care Med. 1994;20:588–90.CrossRefGoogle Scholar
  36. 36.
    Malbrain ML. Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med. 2004;30:357–71.CrossRefGoogle Scholar
  37. 37.
    Cheatham ML, White MW, Sagraves SG, Johnson JL, Block EF. Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J Trauma. 2000;49:621–6; discussion 6–7.CrossRefGoogle Scholar
  38. 38.
    Al-Dorzi HM, Tamim HM, Rishu AH, Aljumah A, Arabi YM. Intra-abdominal pressure and abdominal perfusion pressure in cirrhotic patients with septic shock. Ann Intensiv Care. 2012;2 Suppl 1:S4.CrossRefGoogle Scholar
  39. 39.
    De Laet I, Hoste E, Verholen E, De Waele JJ. The effect of neuromuscular blockers in patients with intra-abdominal hypertension. Intensive Care Med. 2007;33:1811–4.CrossRefGoogle Scholar
  40. 40.
    Corcos AC, Sherman HF. Percutaneous treatment of secondary abdominal compartment syndrome. J Trauma. 2001;51:1062–4.PubMedGoogle Scholar
  41. 41.
    Savino JA, Cerabona T, Agarwal N, Byrne D. Manipulation of ascitic fluid pressure in cirrhotics to optimize hemodynamic and renal function. Ann Surg. 1988;208:504–11.CrossRefGoogle Scholar
  42. 42.
    De Waele JJ, Hoste EA, Malbrain ML. Decompressive laparotomy for abdominal compartment syndrome – a critical analysis. Crit Care. 2006;10:R51.CrossRefGoogle Scholar
  43. 43.
    Miller RS, Morris Jr JA, Diaz Jr JJ, Herring MB, May AK. Complications after 344 damage-control open celiotomies. J Trauma. 2005;59:1365–71; discussion 71–4.CrossRefGoogle Scholar
  44. 44.
    Cheatham ML, Safcsak K, Brzezinski SJ, Lube MW. Nitrogen balance, protein loss, and the open abdomen. Crit Care Med. 2007;35:127–31.CrossRefGoogle Scholar
  45. 45.
    Agalar F, Eroglu E, Bulbul M, Agalar C, Tarhan OR, Sari M. Staged abdominal repair for treatment of moderate to severe secondary peritonitis. World J Surg. 2005;29:240–4.CrossRefGoogle Scholar
  46. 46.
    Holzheimer RG, Gathof B. Re-operation for complicated secondary peritonitis – how to identify patients at risk for persistent sepsis. Eur J Med Res. 2003;8:125–34.PubMedGoogle Scholar
  47. 47.
    Gracias VH, Braslow B, Johnson J, et al. Abdominal compartment syndrome in the open abdomen. Arch Surg. 2002;137:1298–300.CrossRefGoogle Scholar
  48. 48.
    Fernandez L, Norwood S, Roettger R, Wilkins 3rd HE. Temporary intravenous bag silo closure in severe abdominal trauma. J Trauma. 1996;40:258–60.CrossRefGoogle Scholar
  49. 49.
    Boele van Hensbroek P, Wind J, Dijkgraaf MG, Busch OR, Goslings JC. Temporary closure of the open abdomen: a systematic review on delayed primary fascial closure in patients with an open abdomen. World J Surg. 2009;33:199–207.CrossRefGoogle Scholar
  50. 50.
    Weinberg JA, George RL, Griffin RL, et al. Closing the open abdomen: improved success with Wittmann Patch staged abdominal closure. J Trauma. 2008;65:345–8.CrossRefGoogle Scholar
  51. 51.
    Vertrees A, Kellicut D, Ottman S, Peoples G, Shriver C. Early definitive abdominal closure using serial closure technique on injured soldiers returning from Afghanistan and Iraq. J Am Coll Surg. 2006;202:762–72.CrossRefGoogle Scholar
  52. 52.
    Barker DE, Kaufman HJ, Smith LA, Ciraulo DL, Richart CL, Burns RP. Vacuum pack technique of temporary abdominal closure: a 7-year experience with 112 patients. J Trauma. 2000;48:201–6; discussion 6–7.CrossRefGoogle Scholar
  53. 53.
    Brock WB, Barker DE, Burns RP. Temporary closure of open abdominal wounds: the vacuum pack. Am Surg. 1995;61:30–5.PubMedGoogle Scholar
  54. 54.
    Miller PR, Meredith JW, Johnson JC, Chang MC. Prospective evaluation of vacuum-assisted fascial closure after open abdomen: planned ventral hernia rate is substantially reduced. Ann Surg. 2004;239:608–14; discussion 14–6.CrossRefGoogle Scholar
  55. 55.
    Cheatham ML, Demetriades D, Fabian TC, et al. Prospective study examining clinical outcomes associated with a negative pressure wound therapy system and Barker’s vacuum packing technique. World J Surg. 2013;37:2018–30.CrossRefGoogle Scholar
  56. 56.
    Biffl WL, Moore EE, Burch JM, Offner PJ, Franciose RJ, Johnson JL. Secondary abdominal compartment syndrome is a highly lethal event. Am J Surg. 2001;182:645–8.CrossRefGoogle Scholar
  57. 57.
    Patel NY, Cogbill TH, Kallies KJ, Mathiason MA. Temporary abdominal closure: long-term outcomes. J Trauma. 2011;70:769–74.CrossRefGoogle Scholar
  58. 58.
    Sailes FC, Walls J, Guelig D, et al. Synthetic and biological mesh in component separation: a 10-year single institution review. Ann Plast Surg. 2010;64:696–8.PubMedGoogle Scholar
  59. 59.
    Diaz Jr JJ, Guy J, Berkes MB, Guillamondegui O, Miller RS. Acellular dermal allograft for ventral hernia repair in the compromised surgical field. Am Surg. 2006;72:1181–7; discussion 7–8.PubMedGoogle Scholar
  60. 60.
    Jin J, Rosen MJ, Blatnik J, et al. Use of acellular dermal matrix for complicated ventral hernia repair: does technique affect outcomes? J Am Coll Surg. 2007;205:654–60.CrossRefGoogle Scholar
  61. 61.
    Jernigan TW, Fabian TC, Croce MA, et al. Staged management of giant abdominal wall defects: acute and long-term results. Ann Surg. 2003;238:349–55; discussion 55–7.PubMedPubMedCentralGoogle Scholar
  62. 62.
    Rao M, Burke D, Finan PJ, Sagar PM. The use of vacuum-assisted closure of abdominal wounds: a word of caution. Colorectal Dis. 2007;9:266–8.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Open Access This chapter is licensed under the terms of the Creative Commons Attribution-NonCommercial 2.5 International License (, which permits any noncommercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Authors and Affiliations

  1. 1.Department of SurgeryGeorge Washington UniversityWashington DCUSA

Personalised recommendations