Intra-abdominal Hypertension and Abdominal Compartment Syndrome in Acute Care Surgery

Abstract

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS), the pathophysiologic manifestations of elevated intra-abdominal pressure (IAP), are commonly encountered, but underappreciated causes of morbidity and mortality among acute care surgery patients. Every attempt should be made to avoid elevated IAP due to its detrimental physiologic effects. The therapeutic decisions made by the acute care surgeon with regard to IAH/ACS have far-reaching implications on the patient’s subsequent hospital course and survival. In the operating room, staged laparotomy and temporary abdominal closure should be strongly considered in patients who are deemed too ill to tolerate definitive repair, when abdominal contamination cannot be safely controlled during a single procedure, or when primary fascial closure would place the patient at risk for postoperative IAH/ACS. In the intensive care unit, serial IAP measurements, optimization of systemic perfusion and end-organ function, institution of multi-modality medical management strategies to reduce IAP to less injurious levels, and prompt surgical decompression for refractory IAH/ACS are essential to the successful treatment of these patients. Throughout the patient’s hospital course, meticulous surgical management and attention to detail are essential to reducing patient morbidity and mortality as well as achieving the desired goal of definitive primary fascial closure.