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. 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.

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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

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