Diagnosis and treatment of abdominal syndrome

Abdominal compartment syndrome (ACS) refers to end-organ dysfunction brought on by intra-abdominal hypertension (IAH) (Gestring, 2023). ACS is defined as persistent intra-abdominal pressure greater than 20 mm Hg that’s related to latest end-organ dysfunction (Gestring, 2023). Causes of ACS include trauma, severe burns, post-liver transplant conditions, intestinal obstruction, massive ascites, intra-abdominal surgery, intra- or retroperitoneal hemorrhage, and edema secondary to large-volume resuscitation (Klingensmith and Wise, 2019). As intra-abdominal pressure increases, venous return is impaired, causing impaired cardiac and pulmonary function, impaired renal function, decreased intestinal perfusion, and increased intracranial pressure (Gestring, 2023).

Signs and symptoms of ACS

Most patients who develop ACS are critically sick and are likely unable to speak, nonetheless, those that are capable of communicate may report weakness, abdominal pain/bloating, and shortness of breath (Gestring, 2023). ACS physical examination findings include abdominal distension, progressive oliguria, increased ventilatory requirements, hypotension, tachycardia, increased jugular venous pressure, peripheral edema, and abdominal tenderness (Gestring, 2023).

ACS diagnosis

ACS is diagnosed by intra-abdominal pressure measurement, which should at all times be performed, even when there may be little suspicion based on the clinical findings. Measuring bladder pressure is an ordinary screening method for IAH or ACS. Bladder pressure is measured using a Foley catheter; the pressure is measured with the patient lying down, at the top of exhalation, after ensuring that there are not any abdominal muscle spasms (using chemical paralyzing agents could also be mandatory). A measurement from 20 mm Hg to 30 mm HG with signs of end-organ dysfunction allows for the diagnosis of ACS and requires rapid intervention (Klingensmith and Wise, 2019).

Management of atopic dermatitis

Treatment for ACS includes supportive care and interim measures including patient positioning, pain control and sedation, chemical paralysis, nasogastric decompression, ascites/hematoma evacuation, or bladder or bowel decompression (Klingensmith et al., 2008). Surgical decompression is often indicated in patients with intra-abdominal pressure > 20 mm Hg. Surgical decompression might be performed on the bedside within the intensive care unit if the patient is unstable, or within the operating room. The standard technique is decompressive laparotomy (Gestring, 2023). Most commonly, surgical decompression for ACS maintains an open abdomen with temporary closure of the abdominal wall with delayed primary closure after edema subsides (Klingensmith and Wise, 2019).

ACS is a life-threatening complication characterised by high morbidity and mortality. Failure to acknowledge ACS can result in multi-organ failure and death.

Gestring, M. (2023, June 20). Abdominal compartment syndrome in adults. https://www.uptodate.com/contents/abdominal-compartment-syndrome-in-adults

Klingensmith, M., and Wise, P. (2019). Washington textbook of surgery, 8^vol edition. Wolters Kluwer.