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Introduction

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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.

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Definitions and Terms

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  • ▪  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
    • —Pancreatitis
  • ▪  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
    • —Sepsis
    • —Large area full-thickness burns
  • ▪  Chronic ACS:
    • —Cirrhosis
    • —Peritoneal dialysis
    • —Meig syndrome

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Figure 46-1.
Graphic Jump Location

Graphic of ACS showing veno-caval compression.

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Techniques

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  • ▪  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 (Figure 46-2):
      • • 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 cm H2O
      Figure 46-2.Graphic Jump Location

      Graphic showing bladder pressure measurement as a surrogate for intra-abdominal pressure.

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Figure 46-2.
Graphic Jump Location

Graphic showing bladder pressure measurement as a surrogate for intra-abdominal pressure.

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Clinical Pearls and Pitfalls

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  • ▪  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.

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Suggested Reading

Burch JM, Moore EE, Moore FA, Franciose R. The abdominal compartment syndrome. Surg Clin North Am. 1996;76:833–842.  [PubMed: 8782476]
Kirkpatrick AW, Balogh Z, Ball CG, et al. The secondary abdominal compartment syndrome: iatrogenic or unavoidable? J Am Coll Surg. 2006;202:668–679.  [PubMed: 16571439]
Sugrue M. Abdominal compartment syndrome. Curr Opin Crit Care. 2005;11:333–338.  [PubMed: 16015111]

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