Abstract
Purpose
Two cases of abdominal compartment syndrome are described and the pathophysiology associated with it is reviewed.
Clinical Features
The first patient was a 46-yr-old man who sustained extensive blunt abdominal injuries following a fall. The second was a 54-yr-old man involved in a motor vehicle accident with blunt abdominal trauma. In both cases, the patients developed an extremely tense abdomen, increasing peak inspiratory pressures, hypercarbia and oliguna. Both demonstrated improvement in cardiac performance and ventilatory vanables following an emergency decompressive celiotomy.
Conclusion
Abdominal compartment syndrome results in impairment of organ function secondary to increased intraabdominal pressure. These patients require emergency decompressive celiotomy to relieve the symptoms. However, the incidence of intractable asystole and hypotension dunng this procedure is high and vigilance must be maintained dunng the release of the increased intraabdominal pressure.
Résumé
Objectif
Rapporter deux cas de syndrome du compartiment abdominal et revoir sa physiopathologie.
Éléments cliniques
Le premier patient était un homme de 46 ans souffrant de contusions abdominales multiples graves consécutives à une chute. Le deuxième était un homme de 54 ans victime d’un accident de la route et affligé d’une contusion abdominale. Dans les deux cas, l’abdomen était devenu extrêmement tendu avec augmentation des pressions respiratoires maximales, de l’hypercarbie et de l’oligurie. Une coeliotomie décompressive en urgence a permis de normaliser la performance cardiaque et les paramètres ventilatoires.
Conclusion
Le syndrome du compartiment abdominal provoque un atteinte fonctionnelle organique secondaire à l’augmentation de la pression intra-abdominale. Son traitement nécessite une coeliotomie décompressive en urgence. Cependant, l’incidence d’asystolie et d’hypotension réfractaires pendant cette intervention demeure élevée. Il faut exercer une vigilance accrue au moment du relâchement de la pression intra-abdominale.
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Reeves, S.T., Pinosky, M.L., Byrne, T.K. et al. Abdominal compartment syndrome. Can J Anaesth 44, 308–312 (1997). https://doi.org/10.1007/BF03015370
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DOI: https://doi.org/10.1007/BF03015370