The abdominal compartment syndrome and the importance of decompressive re-laparotomy

• Published in: Il Giornale di chirurgia Vol. 31; no. 11-12; pp. 560 - 574
• Main Authors: Cirocchi, R, Barillaro, I, Boselli, C, Covarelli, P, Grassi, V, Cacurri, A, Koltraka, B, Santoro, A, Spizzirri, A, Trastulli, S, Di Patrizi, M, Pressi, E, Gullà, N, Noya, G, Sciannameo, F
• Format: Journal Article
• Language: Italian
• Published: Italy 01.11.2010
• Subjects: Abdominal Cavity - physiopathology; Abdominal Cavity - surgery; Adult; Aged; Aged, 80 and over; Algorithms; Compartment Syndromes - diagnosis; Compartment Syndromes - epidemiology; Compartment Syndromes - etiology; Compartment Syndromes - physiopathology; Compartment Syndromes - surgery; Decompression, Surgical - methods; Female; Humans; Laparotomy - adverse effects; Male; Middle Aged; Prevalence; Reoperation; Retrospective Studies; Risk Factors; Treatment Outcome
• ISSN: 0391-9005

the Abdominal Compartment Syndrome (ACS) is an increasingly recognized complication of both medical and surgical patients. The World Society of the Abdominal Compartmental Syndrome defined Intra Abdominal Hypertension (IAH) as a mean Intra Abdominal Pressure (IAP) ≥ 12 mm Hg and the ACS as IAP ≥ 20 mmHg (with or without an abdominal perfusion pressure < 60 mm Hg) that is associated with dysfunction or failure of one or more organ systems that was not previously present. The IAH contributes to organ failure in patients with abdominal trauma and sepsis and leads to the development of ACS. This study aims to investigate the clinical significance of IAH, the prevalence of ACS and the importance to the effects to the abdominal decompressive re-laparotomy. Patients and methods. The study included 10 patients, 4 men and 6 women with an average age of 68 years (range, 38-86) operated and and treated with xifo-pubic laparotomy between January 2007 and December 2008. According to gold-standard methods, we measured the IAP by indirect measurement using the transvescical route via Foley bladder catheter. among 10 patients with laparotomy, 8 patients (80%) developed IAH < 20 mm Hg but they have not reported significant organ dysfunction , while 2 patients (20%) developed an IAH > 20 mm Hg associated whit organ dysfunction. For this reason, the last 2 patients were undergoing to the decompressive re-laparotomy with temporary closure. in according to our experience and the results of the literature, we believe essential monitoring abdominal pressure in patients with abdominal laparotomy. The abdominal decompressive re-laparotomy is a useful procedure to reduce symptoms and improve the health of the patient.