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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.

Definitions and Terms

  • ▪  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

Figure 46-1.

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

Figure 46-2.

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.

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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