Abdominal compartment syndrome (ACS) occurs when intra-abdominal
pressure increases to the point that it exceeds pressure in the
inferior vena cava and prevents venous return to the heart.
- ▪ Primary ACS: Accumulation of fluid in the abdomen
due to acute intra-abdominal process (Figure 46-1):
- —Penetrating or blunt trauma to the abdomen
or pelvis with hemorrhage
- —Abdominal crush injury
- —Intra-abdominal vascular rupture or injury
- —Bowel perforation
- ▪ Secondary ACS: Accumulation of fluid in abdomen without
obvious abdominal injury:
- —Large volume fluid resuscitation
- —Postoperative third-spacing of fluid into peritoneum
and bowel edema
- —Abdominal packing
- —Large area full-thickness burns
- ▪ Chronic ACS:
- —Peritoneal dialysis
- —Meig syndrome
Graphic of ACS showing veno-caval compression.
- ▪ The diagnosis of ACS requires a high index of clinical
suspicion in the appropriate clinical setting.
- ▪ Diagnosis is typically made by measuring intra-abdominal
pressure by transducing bladder pressure.
- ▪ Measurement of intra-abdominal pressure:
- —Urinary drainage catheter is clamped.
- —A needle connecting a fluid column to a transducer
is introduced through the wall of the catheter and pressure is transduced
- • Grade I ACS: pressure 10 to 15 cm H2O
- • Grade II ACS: pressure 16 to 25 H2O
- • Grade III ACS: pressure 26 to 35 cm H2O
- • Grade IV ACS: pressure > 35
Graphic showing bladder pressure measurement as a surrogate
for intra-abdominal pressure.
Clinical Pearls and Pitfalls
- ▪ Patients
with ACS may have increased airway pressures.
- ▪ The diagnoses
of pericardial tamponade and tension pneumothorax may be suspected
when the patient actually has ACS.
Burch JM, Moore EE, Moore FA, Franciose R. The abdominal compartment
syndrome. Surg Clin North Am.
Kirkpatrick AW, Balogh Z, Ball CG, et al. The secondary abdominal
compartment syndrome: iatrogenic or unavoidable? J Am Coll Surg.
Sugrue M. Abdominal compartment syndrome. Curr Opin Crit Care.