Abdominal Compartment Syndrome

We considered one of the most complicated problems of surgery and intensive care — abdominal compartment syndrome. It is a severe, and in some cases lethal complication developing in major injuries and pathology of abdominal cavity and retroperitoneal space, as well as in extra-abdominal pathology. In addition, compartment syndrome can be the complication of a number of surgical procedures accompanied primarily by laparotomy wound closure with tissue tension. We demonstrated the classification of the complication taking into consideration the etiology, pathogenesis of intra-abdominal hypertension development, the significance of intra-abdominal pressure level, as well as its role in multi-organ failure development. We considered the methods of intra-abdominal pressure measurement, and the urinary pressure measurement using Unometer™Abdo-Pressure™ device turned out to be the most accurate, simple and safe. The preventive and treatment modalities of abdominal compartment syndrome were described. The monitoring of intra-abdominal pressure level in risk group patients, adequate infusion therapy, timely decompression (nasogastrointestinal intubation, decompressive laparotomy), and optimal respiratory support conditions are of primary importance.

1. Hunter J.G. Laparoscopic pneumoperitoneum: the abdominal compartment syndrome revisited. J Am Coll Surg 1995 Nov; 181(5): 469–470.
2. Cheatham M.L., Ivatury R.R., Malbrain M.L., Sugrue M. Options and challenges for the future. In: Abdominal compartment syndrome. Ivatury R., Cheatham M., Malbrain M., Sugrue M. (editors). Georgetown: Landes Bioscience; 2006; p. 295–300.
3. Burch J.M., Moore Е.Е., Moore F.A., Franciose R. The abdominal compartment syndrome. Surg Clin North Am 1996 Aug; 76(4): 833–842.
4. Ertel W., Trentz O. The abdominal compartment syndrome. Der Unfallchirurg 2001; 104(7): 560–568.
5. Rubinson R.M., Vasco J.S., Doppman J.L., Morrow A.G. Inferior caval obstruction fron increased intra-abdominal pressure. Arch Surg 1967; 94: 766–770.
6. Yukioka Т., Muraoka A., Kanai N. Abdominal compartment syndrome following damage-control surgery: pathophysiology and decompression of intraabdominal pressure. Nippon Geka Gakkai Zasshi 2002 Jul; 103(7): 529–535.
7. Barnes G.E., Laine G.A., Giam P.Y., Smith E.E., Granger H.J. Cardiovascular responses to elevation of intra-abdominal hydrostatic pressure. Am J Physiol 1988; 248: 208–213.
8. Berger P., Nijsten M.W., Paling J.C., Zwaveling J.H. The abdominal compartment syndrome: a complication with many faces. Neth J Med 2001 May; 58(5): 197–203.
9. Biffl W.L., Moore E.E., Burch J.M., Offner P.J., Franciose R.J., Johnson J.L. Secondary abdominal compartment syndrome is a highly lethal event. Am J Surg 2001 Dec; 182(6): 645–648.
10. Birkhahn B.H., Gaeta T.J. Abdominal compartment syndrome in a patient with congenital megacolon. Pediat Emerg Care 2000 Jun; 16(3): 176–178.
11. Sanchez N.C., Tenofsky P.L., Dort J.M., Shen L.Y., Helmer S.D., Smith R.S. What is normal intra-abdominal pressure? Am Surg 2001 Mar; 67(3): 243–248.
12. Ivy M.E., Atweh N.A., Palmer J., Possenti P.P., Pineau M., D’Aiuto M. Intra-abdominal hypertension and abdominal compartment syndrome in burn patients. J Trauma 2000; 49: 387–391.
13. Chen R.J., Fang J.F., Lin В.С., Kao J.L. Laparoscopic decompression of abdominal compartment syndrome after blunt hepatic trauma. Surg Endosc 2000 Oct; 14(10): 966.
14. Fritsch D.E., Steinmann R.A. Managing trauma patients with abdominal compartment syndrome. Crit Care Nurs 2000 Dec; 20(6): 48–58.
15. Yang E.Y., Marder S.R., Hastings G., Knudson M.M. The abdominal compartment syndrome complicating nonoperative management of major blunt liver injuries: recognition and treatment using multimodality therapy. J Trauma 2002 May; 52(5): 982–986.
16. Aspesi M., Gamberoni C., Severgnini P., Colombo G., Chiumello D., Minoja G., et al. The abdominal compartment syndrome. Clinical relevance. Minerva Anestesiol 2002 Apr; 68(4): 138–146.
17. Guloglu R. Abdominal compartment syndrome. Ulus Travma Derg 2002 Jul; 8(3): 133–136.
18. Dabney A., Bastani B. Enoxaparin-associated severe retroperitoneal bleeding and abdominal compartment syndrome: a report of two cases. Intens Care Med 2001 Dec; 27(12): 1954–1957.
19. Pottecher T., Segura P., Launoy A. Abdominal compartment syndrome. Ann Chir 2001 Apr; 126(3): 192–200.
20. Garcia С., Parramon F., Delas F., Codina A., Plaja I., Arxer T., Villalonga A. Abdominal compartmental syndrome in non-injured patients. Rev Esp Anestesiol Reanimatol 2000 Mar; 47(3): 126–129.
21. Gecelter G., Fahoum В., Gardezi S., Schein M. Abdominal compartment syndrome in severe acute pancreatitis: an indication for a decompressing laparotomy? Dig Surg 2002; 19(5): 402–405.
22. Blinderman С., Lapid O., Shaked G. Abdominal compartment syndrome in a burn patient. Isr Med Ass J 2002 Oct; 4(10): 833–834.
23. Ivy M.E., Possenti P.P., Kepros J., Atweh N.A., D’Aiuto M., Palmer J., et al. Abdominal compartment syndrome in patients with burns. J Burn Care Rehabil 1999 Sep–Oct; 20(5): 351–353.
24. Latenser B.A., Kowal-Vern A., Kimball D., Chakrin A., Dujovny N. A pilot study comparing percutaneous decompression with decompressive laparotomy for acute abdominal compartment syndrome in thermal injury. J Burn Care Rehabil 2002 May–Jun; 23(3): 190–195.
25. Schachtrupp A., Hoer J., Tons C., Klinge U., Reckord U., Schumpelick V., et al. Intra-abdominal pressure: a reliable criterion for laparostomy closure? Hernia 2002 Sep; 6(3): 102–107.
26. Cleva Rd.R., Silva F.P., Zilberstein В., Machado D.J. Acute renal failure due to abdominal compartment syndrome: report on four cases and literature review. Rev Hosp Clin Fac Med San Paulo 2001 Jul–Aug; 56(4): 123–130.
27. Carlo V.M., Ramirez Schon G., Suarez Irrizary G., Villareal Olivas D., Camps Barazoin J., Medina Torres A. The abdominal compartment syndrome: a report of 3 cases including instance of endocrine induction. Biol Ass Med P R 1998 Jul–Dec; 90(7–12): 121–125.
28. Kopelman T., Harris C., Miller R., Arrillaga A. Abdominal compartment syndrome in patients with isolated extraperitoneal injuries. J Trauma 2000 Осt; 49(4): 744–747; discussion 747–749.
29. Maxwell R.A., Fabian T.C., Croce M.A., Davis K.A. Secondary abdominal compartment syndrome: an underappreciated manifestation of severe hemorrhagic shock. J Trauma 1999 Dec; 47(6): 995–999.
30. Fraipont V., Lambermont В., Ghaye В., Moonen M., Edzang L., D'Orio V., et al. Unusual complication after percutaneous dilatational tracheostomy: pneumoperitoneum with abdominal compartment syndrome. Intens Care Med 1999 Nov; 25(11): 1334–1335.
31. von Gruenigen V.E., Coleman R.L., King M.R., Miller D.S. Abdominal compartment syndrome in gynecologic surgery. Obstet Gynecol l999 Nov; 94(5 Pt 2): 830–832.
32. Neville H.L., Lally K.P., Cox C.S.Jr. Emergent abdominal decompression with patch abdominoplasty in the pediatric patient. J Pediat Surg 2000 May; 35(5): 705–708.
33. Hayakawa M., Gando S., Kameue T. Abdominal compartment syndrome and intrahepatic portal venous gas: a possible complication of endoscopy. Intens Care Med 2002 Nov; 28(11): 1680–1681.
34. Rendl K.H., Prenner K. Intra-abdominal compartment syndrome as a rare complication after aortic reconstruction. Vasa 1992; 21(1): 81–84.
35. Sullivan K.M., Battey P.M., Miller J.S., McKinnon W.M., Skardasis G.M. Abdominal compartment syndrome after mesenteric revascularization. J Vasc Surg 2001 Sep; 34(3): 559–561.
36. Alberti A., Giannetto G., Littori F., Di Marco D., Dattola P., Dattola A., Basile M. Abdominal compartment syndrome in video laparoscopic surgery. Etiopathogenetic aspects, physiopathology and personal experience. Chir Ital 1998 Mar–Aug; 50(2–4): 35–42.
37. Hunter J.G. Laparoscopic pneumoperitoneum: the abdominal compartment syndrome revisited. J Am Coll Surg l995 Nov; 181(5): 469–470.
38. Bloomfield G., Saggi B., Blocher C., Sugerman H. Physiologic effects of externally applied continuous negative abdominal pressure for intra-abdominal hypertension. J Trauma 1999 Jun; 46(6): 1009–1014; discussion 1014–1016.
39. Ertel W., Trentz O. The abdominal compartment syndrome. Der Unfallchirurg 2001; 104(7): 560–568.
40. Burch J.M., Moore Е.Е., Moore F.A., Franciose R. The abdominal compartment syndrome. Surg Clin North Am 1996 Aug; 76(4): 833–842.
41. Burrows R., Edington J., Robbs J.V. A wolf in wolf’s clothing — the abdominal compartment syndrome. S Afr Med J 1995 Jan; 85(1): 8–46.
42. Caldwell C.B., Ricotta J.J. Changes in visceral blood flow with elevated intraadominal pressure. J Surg Res 1987; 43: 14–20.
43. Gallagher J.J. Description of the procedure for monitoring intra-abdominal pressure via an indwelling urinary catheter. Crit Care Nurs 2000 Feb; 20(1): 87–91.
44. Toens С., Schachtrupp A., Hoer J., Junge K., Klosterhalfen B., Schumpelick V. A porcine model of the abdominal compartment syndrome. Shock 2002 Oct; 18(4): 316–321.
45. Doty J.M., Oda J., Ivatury R.R., Blocher C.R., Christie G.E., Yelon J.A., Sugerman H.J. The effects of hemodynamic shock and increased intra-abdominal pressure on bacterial translocation. J Trauma 2002 Jan; 52(l): 13–17.
46. Varela J.E., Cohn S.M., Giannotti G.D., Dolich M.O., Ramon H., Wiseberg J.A., McKenney M. Near-infrared spectroscopy reflects changes in mesenteric and systemic perfusion during abdominal compartment syndrome. Surgery 2001 Mar; 129(3): 363–370.
47. Sugerman H.J., Bloomfield G.L., Saggi B.W. Multisystem organ failure secondary to increased intraabdominal pressure. Infection 1999 Jan–Feb; 27(l): 61–66.
48. Schachtrupp A., Toens Ch., Ноеr J., Klosterhalfen B., Lawong A.G., Schumpelick V. A 24-h pneumoperitoneum leads to multiple organ impairment in a porcine model. J Surg Res 2002 Jul; 106(l): 37–45.
49. Ivatury R.R., Porter J.M., Simon R.J., Islam S., John R., Stahl W.M. Intra-abdominal hypertension after life-threatening penetrating abdominal trauma: prophylaxis, incidence, and clinical relevance to gastric mucosal pH and abdominal compartment syndrome. J Trauma 1998 Jun; 44(6): 1016–1021; discussion 1021–1023.
50. Saggi В.H., Sugerman H.J., Ivatury R.R., Bloomfield G.L. Abdominal compartment syndrome. J Trauma 1998 Sep; 45(3): 597–669.
51. Cheatham M.L., White M.W., Sagraves S.G., Johnson J.L., Block E.F. Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J Trauma 2000 Oct; 49(4): 621–616; discussion 626–627.
52. Diebel L.N., Dulchavsky S.A., Brown W.J. Splanchnic ischemia and bacterial translocation in the abdominal compartment syndrome. J Trauma 1997 Nov; 43(5): 852–855.
53. Gracias V.Н., Braslow B., Johnson J., Pryor J., Gupta R., Reilly P., Schwab C.W. Abdominal compartment syndrome in the open abdomen. Arch Surg 2002 Nov; 137(11): 1298–1300.
54. Offner P.J., de Souza A.L., Moore E.E., Biffl W.L., Franciose R.J., Johnson J.L., et al. Avoidance of abdominal compartment syndrome in damage-control laparotomy after trauma. Arch Surg 2001 Jun; 136(6): 676–681.
55. Rubinson R.M., Vasco J.S., Doppman J.L., Morrow A.G. Inferior caval obstruction fron increased intra-abdominal pressure. Arch Surg 1967; 94: 766–770.
56. Но K.W., Joynt G.M., Tan P. A comparison of central venous pressure and common iliac venous pressure in critically ill mechanically ventilated patients. Crit Care Med 1998; 26: 461–464.
57. Citerio G., Vascotto E., Villa F., Celotti S., Pesenti A. Induced abdominal compartment syndrome increases intracranial pressure in neurotrauma patients: a prospective study. Crit Care Med 2001 Jul; 29(7): 1466–1471.
58. Doty J.M., Saggi B.H., Sugerman H.J., Fakhry I., Gehr T., Sica D., Sugerman H.J. Effect of increased renal venous pressure on renal function. J Trauma 1999 Dec; 47(6): 1000–1003.
59. Doty J.M., Saggi B.H., Blocher C.R., Fakhry I., Gehr T., Sica D., et al. Effects of increased renal parenchymal pressure on renal function. J Trauma 2000 May; 48(5): 874–877.
60. Meldrum D.R., Moore F.A., Moore Е.Е., Franciose R.J., Sauaia A., Burch J.M. Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg 1997 Dec; 174(6): 667–672.
61. Bloomfield G.L., Ridings P.C., Blocher C.R., Marmarou A., Sugerman H.J. A proposed relationship between increased intra-abdominal, intrathoracic, and intracranial pressure. Crit Care Med 1997 Mar; 25(3): 496–503.
62. Bloomfield G.L., Dalton J.M., Sugerman H.J., Ridings P.C., DeMaria E.J., Bullock R. Treatment of increasing intracranial pressure secondary to the acute abdominal compartment syndrome in a patient with combined abdominal and head trauma. J Trauma 1995 Dec; 39(6): 1168–1170.
63. Tiwari A., Haq A.I., Myint F., Hamilton G. Acute compartment syndromes. Br J Surg 2002 Apr; 89(4): 397–412.
64. Grubben A.C., van Baardwijk A.A., Broering D.C., Hoofwijk A.G. Pathophysiology and clinical significance of the abdominal compartment syndrome. Zentralbl Chir 2001 Aug; 126(8): 605–609.
65. Williams M., Simms H.H. Abdominal compartment syndrome: case reports and implications for management in critically ill patients. Am Surg 1997 Jun; 63(6): 555–558.
66. Morken J., West M.A. Abdominal compartment syndrome in the intensive care unit. Curr Opin Crit Care 2001 Aug; 7(4): 268–274.
67. Nathens A.B., Brenneman F.D., Boulanger B.R. The abdominal compartment syndrome. Can J Surg 1997 Aug; 40(4): 254–258.
68. Overholt R.H. Intraperitoneal pressure. Arch Surg 1931; 22: 691–703.
69. Joynt G.M., Ramsay S.J., Buckley Т.А. Intra-abdominal hypertension-implications for the intensive care physician. Ann Acad Med Singapore 2001 May; 30(3): 310–319.
70. Kron I.L., Harman P.K., Nolan S.P. The measurement of intraabdominal pressure as a criterion for abdominal re-exploration. Ann Surg 1984; 199(1): 28–30.
71. Collee G.G., Lomax D.M., Ferguson С., Hanson G.C. Bedside measurement of intraabdominal pressure (IAP) via an indwelling naso-gastric tube: clinical validation of the technique. Intens Care Med 1993; 19: 478–480.
72. Richardson J.D., Trinkle J.K. Hemodynamic and respiratory alterations with increased intraabdominal pressure. J Surg Res 1976; 20: 401–404.
73. Sun Y.G., Huang Z.H., Song H.J., Zhang Q.G. Clinical observation of abdominal compartment syndrome: report of 11cases. Di Yi Jun Yi Da Xue Xue Bao 2002 Jan; 22(l): 43–44.
74. Loi P., De Backer D., Vincent J.L. Abdominal compartment syndrome. Acta Chir Belg 2001 Mar–Apr; 101(2): 59–64.
75. Corcos A.C., Sherman H.F. Percutaneous treatment of secondary abdominal compartment syndrome. J Trauma 2001 Dec; 51(6): 1062–1064.
76. Raeburn C.D., Moore Е.Е., Biffl W.L., Johnson J.L., Meldrum D.R., Offner P.J., et al. The abdominal compartment syndrome is a morbid complication of postinjury damage control surgery. Am J Surg 2001 Dec; 182(6): 542–546.
77. Engum S.A., Kogon B., Jensen E., Isch J., Balanoff C., Grosfeld J.L. Gastric tonometry and direct intraabdominal pressure monitoring in abdominal compartment syndrome. J Pediat Surg 2002 Feb; 37(2): 214–218.
78. Eddy V., Nunn C., Morris J.A.Jr. Abdominal compartment syndrome. The Nashville experience. Surg Clin North Am 1997 Aug; 77(4): 801–812.
79. Paran H., Mayo A., Afanasiev A., Epstein T., Neufeld D., Kluger Y., Shwartz I. Staged primary closure of the abdominal wall in patients with abdominal compartment syndrome. J Trauma 2001 Dec; 51(6): 1204–1206.
80. Roumen R.M., Rohof M.H., van den Wall Bake A.W. Immediate recovery from acute renal insufficiency after abdominal decompression. Ned Tijdschr Geneeskd 1998 Sep 12; 142(37): 2053–2056.
81. Ertel W., Oberholzer A., Platz A., Stocker R., Trentz O. Abdominal compartment syndrome after severe abdominal and/or pelvic trauma. Langenbecks Arch Chir Suppl Kongressbd 1998; 115: 1189–1190.
82. Tremblay L.N., Feliciano D.V., Schmidt J., Cava R.A., Tchorz K.M., Ingram W.L., et al. Skin only or silo closure in the critically ill patient with an open abdomen. Am J Surg 2001 Dec; 182(6): 670–675.
83. Ciresi D.L., Cali R.F., Senagore A.J. Abdominal closure using nonabsorbable mesh after massive resuscitation prevents abdominal compartment syndrome and gastrointestinal fistula. Am Surg 1999 Aug; 65(8): 720–724; discussion 724–725.
84. Cuthbertson S.J. Nursing care for raised intra-abdominal pressure and abdominal decompression in the critically ill. Intens Crit Care Nurs 2000 Jun; 16(3): 175–180.
85. Reeves S.T., Pinosky M.L., Byrne T.K., Norcross E.D. Abdominal compartment syndrome. Can J Anaesth 1997 Mar; 44(3): 308–312.
86. Gel’fand B.R., Protsenko D.N., Chubchenko S.V., Ignatenko O.V., Yaroshetskiy A.I. Sindrom intraabdominal’noy gipertenzii u khirurgicheskikh bol’nykh: sostoyanie problemy v 2007 godu [Intra-abdominal hypertension syndrome in surgical patients: problem state in 2007]. Infektsii v khirurgii — Infection in Surgery 2007; 5(3): 20–29.
87. Filimonov M.M., Polachin P.V., Chubchenko S.V. Ranevye oslozhneniya pri etapnom khirurgicheskom lechenii peritonita (soobshchenie 2) [Wound complications in staging surgical treatment of peritonitis (report 2)]. Annaly khirurgii — Surgical Records 2006; 1: 21–24.
88. Bogdanov A.A. Sindrom abdominal'nogo kompartmenta [Abdominal compartment syndrome]. Khirurg — Surgeon 2006; 9; 10–13.
89. Timerbulatov V.M., Sakhautdinov R.M., Timerbulatov Sh.V., Muslukhova E.I., Sultanmagomedov I.M. Abdominal'nyy kompartment-sindrom v ekstrennoy khirurgii [Abdominal compartment syndrome in urgent surgery]. Khirurgiya. Zhurnal im. N.I. Pirogova — Surgery. Journal named after N.I. Pirogov 2008; 7: 33–35.
90. Gubaydullin P.P. Narusheniya v sisteme transporta kisloroda i puti ikh korrektsii u bol’nykh s vnutribryushnoy gipertenziey v perioperatsionnom periode. Dis. ... dokt. med. nauk [Oxygen transport system disturbances and the ways of their correction in patients with intra-abdominal hypertension in perioperative period. Abstract for Dissertation for the degree of Doctor of Medical Science]. Moscow; 2005.
91. Malbrain M., Jones F. Intra-abdominal pressure measurement techniques. In: Abdominal compartment syndrome. Ivatury R., Cheatham M., Malbrain M., Sugrue M. (editors). Georgetown: Landes Bioscience 2006; p. 19–68.
92. Malbrain M.L. Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med 2004; 30: 357–371.
93. Bailey J., Shapiro M.J. Abdominal compartment syndrome. Crit Care 2000; 4(1): 23–29.
94. Malbrain M.L. The role of abdominal distension in the search for optimal PEEP in acute lung injury (ALI): PEEP-adjustment for raised intra-abdominal pressure (IAP) or calculation of Pflex? Crit Care Med 1999; 27(Suppl.): A157.
95. Gattinoni L., Pelosi P., Suter P.M., Pedoto A., Vercesi P., Lissoni A. Acute respiratory distress syndrome caused by pulmonary and extrapulmonary disease. Different syndromes? Am J Respir Crit Care Med 1998; 158: 3–11.
96. Ranieri V.M., Brienza N., Santostasi S., Puntillo F., Mascia L., Vitale N., et al. Impairment of lung and chest wall mechanics in patients with acute respiratory distress syndrome. Role of abdominal distension. Am J Respir Crit Care Med 1997; 156(4 Pt 1): 1082–1091.
97. Malbrain M.L. Bladder pressure or super syringe: correlation between intra-abdominal pressure and lower inflection point? Intensive Care Med 1999; 25(Suppl. 1): S110.
98. Mutoh T., Lamm W.J., Embree L.J., Hildebrandt J., Albert R.K. Volume infusion produces abdominal distension, lung compression, and chest wall stiffening in pigs. J Appl Physiol 1992 Feb; 72: 575–582.
99. Malbrain M.L. Abdominal pressure in the critically ill. Curr Opin Crit Care 2000; 6: 17–29.

Ovchinnikov V.А., Sokolov V.А. Abdominal Compartment Syndrome. Sovremennye tehnologii v medicine 2013; 5(1): 122