Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage

• Published in: World journal of gastroenterology : WJG Vol. 14; no. 22; pp. 3541 - 3548
• Main Authors: Chen, Hong, Li, Fei, Sun, Jia-Bang, Jia, Jian-Guo
• Format: Journal Article
• Language: English
• Published: United States Department of General Surgery, Xuan Wu Hospital of Capital Medical University, Beijing 100053, China 14.06.2008; The WJG Press and Baishideng
• Subjects: Abdominal Cavity - physiopathology; Acute Disease; Adult; Aged; Aged, 80 and over; Compartment Syndromes - etiology; Compartment Syndromes - physiopathology; Compartment Syndromes - therapy; Female; Humans; Hypertension - etiology; Hypertension - physiopathology; Hypertension - therapy; Incidence; Lower Body Negative Pressure; Male; Middle Aged; Multiple Organ Failure - etiology; Multiple Organ Failure - physiopathology; Multiple Organ Failure - therapy; Pancreatitis - complications; Prognosis; Rapid Communication; Retrospective Studies; Treatment Outcome; 器官功能; 急性胰腺炎; 腹部疾病综合症; 高血压; Intra-abdominal hypertension; Abdominal compartment syndrome; Intra-abdominal pressure; Acute pancreatitis; Organ dysfunction
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.14.3541

AIM： To study retrospectively the influence of intra-abdominal hypertension （IAH） and abdominal compartment syndrome （ACS） in patients with early acute pancreatitis （AP） （during the first week after admission） on physiological functions, and the association of the presence of IAH/ACS and outcome. METHODS： Patients （n = 74） with AP recruited in this study were divided into two groups according to intra-abdominal pressure （IAP） determined by indirect measurement using the transvesical route via Foley bladder catheter during the first week after admission. Patients （n = 44） with IAP ≥ 12 mmHg were assigned in IAH group, and the remaining patients （n = 30） with IAP 〈 12 mmHg in normal IAP group. For analysis of the influence of IAH/ACS on organ function and outcome, the physiological parameters and the occurrence of organ dysfunction during intensive care unit （ICU） stay were recorded, as were the incidences of pancreatic infection and in-hospital mortality. RESULTS： IAH within the first week after admission was found in 44 patients （59.46%）. Although the APACHE Ⅱ scores on admission and the Ranson scores within 48 h after hospitalization were elevated in IAH patients in early stage, they did not show the statistically significant differences from patients with normal IAP within a week after admission （16.18 ± 3.90 vs 15.70 ± 4.25, P = 0.616; 3.70 ± 0.93 vs 3.47 ± 0.94, P = 0.285, respectively）. ACS in early AP was recorded in 20 patients （27.03%）. During any 24-h period of the first week after admission, the recorded mean IAP correlated significantly with the Marshall score calculated at the same time interval in IAH group （r = 0.635, P 〈 0.001）. Although ACS patients had obvious amelioration in physiological variables within 24 h after decompression, the incidences of pancreatitic infection, septic shock, multiple organ dysfunction syndrome （MODS） and death in the patients with ACS were significantly higher than that in other patients without ACS （pancreatitic infection： 60.0% vs 7.4%, P 〈 0.001; septic shock： 70.0% vs 11.1%, P 〈 0.001; MODS： 90.0% vs 31.5%, P 〈 0.001; mortality： 75.0% vs 3.7%, P 〈 0.001）. CONCLUSION： IAH/ACS is a frequent finding in patients admitted to the ICU because of AP. Patients with IAP at approximately 10-12 mmHg and early signs of changes in physiologic variables should be seriously considered for urgent decompression to improve survival.