Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2008 Jan 30:3:6.
doi: 10.1186/1749-7922-3-6.

Transverse laparostomy is feasible and effective in the treatment of abdominal compartment syndrome in severe acute pancreatitis

Ari Leppäniemi  1 , Panu Mentula, Piia Hienonen, Esko Kemppainen
Affiliations

Transverse laparostomy is feasible and effective in the treatment of abdominal compartment syndrome in severe acute pancreatitis

Ari Leppäniemi et al. World J Emerg Surg. .

Abstract

Background: Only recently has the important role of abdominal compartment syndrome (ACS) been recognized as a contributing factor to the multiple organ failure commonly seen in severe acute pancreatitis (SAP). Decompressive laparostomy for ACS is a life-saving procedure usually performed through a midline incision followed by a negative pressure wound dressing. High risk of intestinal fistulas and frequent inability to close the fascia with ensuing planned ventral hernia has prompted the search for alternative techniques. Subcutaneous fasciotomy may be effective in early and less severe cases of ACS but it is always accompanied with a ventral hernia.

Case report: A patient with SAP developed manifest ACS and was treated with bilateral subcostal laparostomy. Immediately after decompression, the intra-abdominal pressure dropped from 23 mmHg to 10 mmHg, and the respiratory, cardiovascular and renal functions improved markedly leading to full recovery. The abdominal incision including the fascia and the skin was closed gradually over 4 relaparotomies, and during the 6 months' follow up there are no signs of ventral hernia or other wound complications.

Discussion: Transverse subcostal laparostomy is a promising alternative decompression technique for ACS in SAP. It is feasible, effective and might provide a chance of early fascial closure. Comparative studies are needed to define its role as a decompressive technique for ACS.

PubMed Disclaimer

Figures

Figure 1
Figure 1
CT scan on admission. Computed tomography on admission shows peripancreatic oedema, thickening of the Gerota's fascia on the left side and at least two poorly defined fluid collections (in other cuts) corresponding to severe acute pancreatitis with Balthazar grade E [21].
Figure 2
Figure 2
Transverse laparotomy incision. Seen from the patient's right side, a bilateral subcostal incision is being performed with posterior fascia still intact.
Figure 3
Figure 3
Completed laparostomy. Patches of liponecrosis seen on the surface of the greater omentum.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Ball CG, Kirkpatrick AW. Intra-abdominal hypertension and the abdominal compartment syndrome. Scand J Surg. 2007;96:197–204. - PubMed
    1. Isenmann R, Rau B, Beger HG. Early severe acute pancreatitis: characteristics of a new subgroup. Pancreas. 2001;22:274–278. doi: 10.1097/00006676-200104000-00008. - DOI - PubMed
    1. Pupelis G, Austrums E, Snippe K, Berzins M. Clinical significance of increased intra-abdominal pressure in severe acute pancreatitis. Acta Chir Belg. 2002;102:71–74. - PubMed
    1. Pupelis G, Austrums E, Snippe K, Melbarde-Gorkusa I. [Increased intra-abdominal pressure – an important risk factor of early organ dysfunction in severe acute pancreatitis] Zentralblatt Chir. 2002;127:982–986. doi: 10.1055/s-2002-35762. - DOI - PubMed
    1. De Waele JJ, Hoste E, Blot SI, Decruyenaere J, Colardyn F. Intra-abdominal hypertension in patients with severe acute pancreatitis. Crit Care. 2005;9:R452–R457. doi: 10.1186/cc3754. - DOI - PMC - PubMed

LinkOut - more resources