Abdominal compartment syndrome

Abstract

The term abdominal compartment syndrome (ACS) describes the clinical manifestations of the pathologic elevation of the intra-abdominal pressure (IAP). When the IAP exceeds 12 mm Hg it is referred to as intra-abdominal hypertension (IAH) while ACS generally sets in at an IAP in excess of 20 mm Hg. This syndrome is most commonly observed in the setting of severe abdominal trauma and in the aftermath of major abdominal operations. ACS affects mainly the respiratory, cardiovascular, renal, gastrointestinal and the central nervous systems. Fundamental to the development of ACS are the obstruction of venous return to the heart via the inferior vena cava and the splinting of the diaphragm due to elevated IAP. Preventing ACS by the identification of patients at risk and early diagnosis is paramount to its successful management. To this end a high index of suspicion is sine qua non. The management of established ACS requires clinical astuteness and decisiveness with a readily available and generous team support. The purpose of this review is to enhance awareness among clinicians about a subtle condition with a devastating impact on morbidity and mortality if undiagnosed.

Figure 1

Pathophysiology of intra-abdominal hypertension on the cardiovascular (purple arrows), gastrointestinal (green arrows) and the renal (orange arrows) systems producing multisystem organ dysfunction in abdominal compartment syndrome. SIRS = systemic inflammatory response syndrome, GFG = glomerular filtration gradient, GFR = glomerular filtration rate, BF = blood flow.

Figure 2

Pathophysiology of intra-abdominal hypertension on the respiratory (blue arrows) and the central nervous (orange arrows) systems producing multisystem organ dysfunction in abdominal compartment syndrome. CVP = central venous pressure, ICP = intra-cranial pressure, CPP = cerebral perfusion pressure, ARDS = adult respiratory distress syndrome.