Skip to main content

Advertisement

SpringerLink
Log in

Computed tomography features predictive of intra-abdominal hypertension in acute necrotizing pancreatitis:  A prospective study

  • Original Article
  • Published:
Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in acute pancreatitis (AP) are associated with development and worsening of organ failures and poor prognosis. Limited studies suggest that contrast-enhanced computed tomography (CECT) can predict the presence of IAH/ACS. We aimed to study clinical profile of patients with AP and IAH and identify predictive factors of IAH on CECT abdomen.

Methods

Consecutive patients admitted with moderately severe and severe acute pancreatitis (SAP) were recruited. Clinical and radiological data were recorded prospectively. Intra-abdominal pressure was measured via a urinary catheter to document the presence of IAH/ACS. CECT abdomen was done within the first week of admission and various features that may predict the presence of IAH were studied.

Results

Thirty-seven patients (24 SAP) (mean age: 39.78 ± 13.43 years and 67.6% males) with  AP were studied. The most common etiology was alcohol (37.7%). IAH developed in 54.05% of patients; patients with IAH had significantly higher bedside index of severity in AP (BISAP), Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score, persistent acute lung injury (ALI), persistent acute kidney injury (AKI), persistent cardiovascular failure (CVSF), intensive care unit (ICU) stay, and mortality. Among the CT predictors, patients with IAH more commonly had moderate-gross ascites (60% vs. 23.5%, p-value − 0.026), a pancreatic necrosis of > 50% (50% vs. 17.6%, p-value − 0.04), and a round belly sign (RBS) (50% vs. 5.9%, p-value 0.03). On multivariate analysis, only RBS was predictive of  IAH (odds ratio 12.6, 95% confidence interval 1.3–124.2, p-value 0.03). The sensitivity, specificity, positive predictive value, and negative predictive value for RBS were 50%, 94.12%, 90.9%, and 61.54%, respectively.

Conclusion

Presence of RBS, moderate-gross ascites, and pancreatic necrosis of > 50% on CECT can predict the presence of IAH in these groups of patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bollen TL, van Santvoort HC, Besselink MG, et al. The Atlanta classification of acute pancreatitis revisited. Br J Surg. 2008;95:6–21.

  2. Banks PA, Freeman ML, Practice Parameters Committee of the American College of G. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101:2379–400.

    Article  Google Scholar 

  3. Russo MW, Wei JT, Thiny MT, et al. Digestive and liver diseases statistics, 2004. Gastroenterology. 2004;126:1448–53.

  4. Triester SL, Kowdley KV. Prognostic factors in acute pancreatitis. J Clin Gastroenterol. 2002;34:167–76.

    Article  Google Scholar 

  5. Malbrain ML, Deeren D, De Potter TJ. Intra-abdominal hypertension in the critically ill: it is time to pay attention. Curr Opin Crit Care. 2005;11:156–71.

    Article  Google Scholar 

  6. De Waele JJ, Leppaniemi AK. Intra-abdominal hypertension in acute pancreatitis. World J Surg. 2009;33:1128–33.

    Article  Google Scholar 

  7. Al-Bahrani AZ, Abid GH, Holt A, et al. Clinical relevance of intra-abdominal hypertension in patients with severe acute pancreatitis. Pancreas. 2008;36:39–43.

    Article  Google Scholar 

  8. Leppaniemi A, Johansson K, De Waele JJ. Abdominal compartment syndrome and acute pancreatitis. Acta Clin Belg. 2007;62 Suppl 1:131–5.

    Article  Google Scholar 

  9. Mifkovic A, Skultety J, Sykora P, Prochotsky A, Okolicany R. Intra-abdominal hypertension and acute pancreatitis. Bratisl Lek Listy. 2013;114:166–71.

  10. Aitken EL, Gough V, Jones A, MacDonald A. Observational study of intra-abdominal pressure monitoring in acute pancreatitis. Surgery. 2014;155:910–8.

    Article  Google Scholar 

  11. Chen H, Li F, Sun JB, Jia JG. Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage. World J Gastroenterol. 2008;14:3541–8.

    Article  Google Scholar 

  12. Fusco MA, Martin RS, Chang MC. Estimation of intra-abdominal pressure by bladder pressure measurement: validity and methodology. J Trauma. 2001;50:297–302.

    Article  CAS  Google Scholar 

  13. Al-Bahrani AZ, Abid GH, Sahgal E, O'shea S, Lee S, Ammori BJ. A prospective evaluation of CT features predictive of intra-abdominal hypertension and abdominal compartment syndrome in critically ill surgical patients. Clin Radiol. 2007;62:676–82. 

  14. Wu J, Zhu Q, Zhu W, Chen W, Wang S. Computed tomographic features of abdominal compartment syndrome complicated by severe acute pancreatitis. Zhonghua Yi Xue Za Zhi. 2014;94:3378–81.

    PubMed  Google Scholar 

  15. Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102–11.

  16. Balthazar EJ. Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology. 2002;223:603–13.

    Article  Google Scholar 

  17. Mortele KJ, Wiesner W, Intriere L, et al. A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. AJR Am J Roentgenol. 2004;183:1261–5.

  18. Malbrain ML, De Laet IE, De Waele JJ, Kirkpatrick AW. Intra-abdominal hypertension: definitions, monitoring, interpretation and management. Best Pract Res Clin Anaesthesiol. 2013;27:249–70.

    Article  Google Scholar 

  19. Ke L, Ni HB, Sun JK, et al. Risk factors and outcome of intra-abdominal hypertension in patients with severe acute pancreatitis. World J Surg. 2012;36:171–8.

  20. Pupelis G, Austrums E, Snippe K, Berzins M. Clinical significance of increased intraabdominal pressure in severe acute pancreatitis. Acta Chir Belg. 2002;102:71–4.

    Article  CAS  Google Scholar 

  21. Zhao JG, Liao Q, Zhao YP, Hu Y. Mortality indicators and risk factors for intra-abdominal hypertension in severe acute pancreatitis. Int Surg. 2014;99:252–7.

    Article  CAS  Google Scholar 

  22. Bhandari V, Jaipuria J, Singh M, Chawla AS. Intra-abdominal pressure in the early phase of severe acute pancreatitis: canary in a coal mine? Results from a rigorous validation protocol. Gut Liver. 2013;7:731–8.

    Article  Google Scholar 

  23. Dambrauskas Z, Parseliunas A, Gulbinas A, Pundzius J, Barauskas G. Early recognition of abdominal compartment syndrome in patients with acute pancreatitis. World J Gastroenterol. 2009;15:717–21. 

    Article  Google Scholar 

  24. 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.

    Article  Google Scholar 

  25. Pickhardt PJ, Shimony JS, Heiken JP, Buchman TG, Fisher AJ. The abdominal compartment syndrome: CT findings. AJR Am J Roentgenol. 1999;173:575–9. 

    Article  CAS  Google Scholar 

  26. Patel A, Lall CG, Jennings SG, Sandrasegaran K. Abdominal compartment syndrome. AJR Am J Roentgenol. 2007;189:1037–43.

    Article  Google Scholar 

  27. Zissin R. The significance of a positive round belly sign on CT. AJR Am J Roentgenol. 2000;175:267–8.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Gastroenterology, and Radiodiagnosis, Post Graduate Institute of Medical Education and Research , Sector 12, Chandigarh, 160 012, India

    Suhang Verma, Surinder S. Rana, Mandeep Kang & Ujjwal Gorsi

  2. Department of Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research , Sector 12, Chandigarh, 160 012, India

    Rajesh Gupta

Authors
  1. Suhang Verma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Surinder S. Rana
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mandeep Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ujjwal Gorsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rajesh Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Surinder S. Rana.

Ethics declarations

Conflict of interest

SV, SSR, MK, UG, and RG declare no competing interests.

Ethics statement

The study was performed conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Disclaimer

The authors are solely responsible for the data and the contents of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, the Indian Society of Gastroenterology or the printer/publishers are responsible for the results/findings and content of this article.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(DOCX 12 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Verma, S., Rana, S.S., Kang, M. et al. Computed tomography features predictive of intra-abdominal hypertension in acute necrotizing pancreatitis:  A prospective study. Indian J Gastroenterol 40, 326–332 (2021). https://doi.org/10.1007/s12664-021-01149-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12664-021-01149-9

Keywords

Search

Navigation