Chapter 46. Abdominal Compartment Syndrome Diagnosis

Introduction

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

Techniques

• ▪  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

    

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    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.

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