بسم الله الرحمن الرحيم  (( وقل رب زدني علما )) 

Abdominal Compartment Syndrome  Dr.Saad AL-Qahtani Department of Surgery College of medicine, King Saud University

Abdominal Compartment Syndrome When IAP > 20 mmHg this is called “intra-abdominal hypertension” But if IAP >25-30 with at least one of the followings : compromised respiratory mechanisms & ventilation, oliguria or anuria or increase in ICP ,this is “Abdominal Compartment Syndrome”

Abdominal Compartment Syndrome Normal IAP < 10 mmHg Grade: I 10 – 15 mmHg II 16 – 25 mmHg III 26 – 35 mmHg IV > 35 mmHg

Abdominal Compartment Syndrome Eitiology Surgical 1-Trauma 2-post liver transplantation. 3-tight surgical closures or burn scars. 4-others ; ruptured AAA, pancreatic &intestinal injury will increase risk of development of IAH &ACS Non-surgical bowel obstruction ,pancreatitis , massive ascites, peritonitis ,….

Abdominal Compartment Syndrome Progressive abd distetion Increased peak airway ventilator pressure Oliguria &anuria Intracranial hypertension

Abdominal Compartment Syndrome CNS Intra thoracic pressure + central venous pressure ICP An elevated CVP &ICP with hypotension cerebral flow&ischemia. CVS Reduction of CO ,Venous return. Hypovolemia. Increase in PCWP , CVP. DVT.

Abdominal Compartment Syndrome Pulmonary Increase in ITP, airway pressure, shunt fracion. Hypoxia , hypercarbia. Compression of chest lead to : atelectasis, edema ,infection. Renal Reduction in UO, GFR, ,….. Renal failure

Abdominal Compartment Syndrome ABDOMEN CELIAC &SMA flow. Compressionn of veins , venous HTN, intestinal edema , ….. Hypoperfusion , bowel ischemia & Lactic acidosis.

ACS : Bowel Edema Capillary Hydrostatic Pressure Endothelial Permeability Capillary Hydrostatic Pressure Plasma Oncotic Pressure Transcapillary Fluid Flux Mesenteric Lymphatic Resistance Shock 2003

Abdominal Compartment Syndrome

Postinjury Damage Control : ACS MOF MOF MORTALITY Raeburn et al Am J Surg 2001 ACS + 32 % 43 % ACS - 8 % 12 %

Abdominal Compartment Syndrome Management -Relase of abdominal fascia & keep it open. -Temporary abd closure techniques. ( vaccum assisted or vaccum pack) -If untreated , multiple system end-organ dysfunction or failure & high mortality.

Abdominal Compartment Syndrome

Abdominal Compartment Syndrome I 10 – 15 mmH maintain normovolemia II 16 – 25 mmHg hypervolemic resuscitation III 26 – 35 mmHg Decompression IV > 35 mmHg Decompression &re- exploration

Summary Primary vs. Secondary Mechanisms Sx : Pulmonary and Renal Dx : Bladder Pressure Monitoring Rx : Prompt Decompression Prevention : ???