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Acute abdominal compartment syndrome: current diagnostic and therapeutic options

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Abstract

Background

If untreated, the abdominal compartment syndrome (ACS) has a mortality of nearly 100 %. Thus, its early recognition is of major importance for daily rounds on surgical intensive care units. Intraabdominal hypertension (IAH) is a poorly recognized entity, which occurs if intraabdominal pressure arises >12 mmHg. Measurement of the intravesical pressure is the gold standard to diagnose IAH, which can be detected in about one fourth of surgical intensive care patients.

Purpose

The aim of this manuscript is to outline the current diagnostic and therapeutic options for IAH and ACS. While diagnosis of IAH and ACS strongly depends on clinical experience, new diagnostic markers could play an important role in the future. Therapy of IAH/ACS consists of five treatment “columns”: intraluminal evacuation, intraabdominal evacuation, improvement of abdominal wall compliance, fluid management, and improved organ perfusion. If conservative therapy fails, emergency laparotomy is the most effective therapeutic approach to achieve abdominal decompression. Thereafter, patients with an open abdomen require intensive care and are permanently threatened by the quadrangle of fluid loss, muscle proteolysis, heat loss, and an impaired immune function. As a consequence, complication rate dramatically increases after 8 days of open abdomen therapy.

Conclusion

Despite many efforts, the mortality of patients with ACS remains unacceptably high. Permanent clinical education and surgical trials will be necessary to improve the outcome of our critically ill surgical patients.

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Abbreviations

ACS:

abdominal compartment syndrome

IAH:

Intraabdominal hypertension

IAP:

intraabdominal pressure

SOFA:

Sequential Organ Failure Assessment

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Author information

Authors and Affiliations

  1. Department of General and Thoracic Surgery, University Hospital of Giessen, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany

    A. Hecker, J. G. Riedel & W. Padberg

  2. Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany

    B. Hecker & M. A. Weigand

  3. Medical Clinic II, Pulmonary and Critical Care Medicine, University Hospital of Giessen, Giessen, Germany

    M. Hecker

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  1. A. Hecker
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Correspondence to A. Hecker.

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Hecker, A., Hecker, B., Hecker, M. et al. Acute abdominal compartment syndrome: current diagnostic and therapeutic options. Langenbecks Arch Surg 401, 15–24 (2016). https://doi.org/10.1007/s00423-015-1353-4

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