1. Acut pancreatitis with intra-abdominal compartment syndrome
충북대학교 병원
소화기내과
pf. 박선미
R3 박순영

2. Chief Complaint : abdominal pain, 3시간 전 Present Illness :
PMH & FH: not remarkable
SH: smoking(-), alcohol(+) 2-3회/w, 2-3병/회
Physical Examination
V/S: BP 110/70mmHq HR 88회/분 RR 24회/분 BT 37.8 ˚C
Periorbital swelling, ecchymosis
Abdomen: RUQ area의 tenderness(+), active bowel sounds

3. Initial Laboratory Finding
Problem lists
#1. Alcohol induced acute pancreatitis
#2. Blowout fracture, med. Rt.
CBC 24900/uL – 13.3g/dL – 40.1% – 304x10^3/uL
BUN/Cr 14.2 mg/dL / 1.82 mg/dL
E 146 mEq/L– 3.7 mEq/L – 111 mEq/L
Amylase/lipase 192 U/L/948I U/L
OT/PT 47 IU/L/24 IU/L, ALP 249 IU/L
LDH 989 IU/L, Glucose 200 mg/dL
hsCRP 0.04 mg/dL

5. Dyspnea(+), tachypnea(+), RR 34/회 CXR : Pulmonary edema(-)
HD #2(Transfer to ICU )
Dyspnea(+), tachypnea(+), RR 34/회
CXR : Pulmonary edema(-)
Assessmement of Acute Pancreatitis Severity
Ranson Criteria
At admission 3점
At 48 hours 4점
CT Severity Index : 2
CBC /uL– 10.9 g/dL– 32.3 % – 195x10^3/uL
ABGA – 24.5mmHg – 100mmHg – 17.0mmol/L
BE-B -5.5mmol/L, BE-ECF -6.2mmol/L
BUN/Cr 22.6mg/dL/1.12mg/dL
Calcium 7.0mg/dL

6. Chest AP: serial FU data
Intubation 시행
ARDS 진행

7. HD #12
Vital signs
90/60mmHq – 130 회/분 – 38회/분 – 37.6 ˚C
Drowsy mental status
Abdomen: tense, no bowel sound
Low tidal volume
ABGA: Respiratory acidosis
Input – Output : 1.5L
Body weight gain : 8kg

8. 67 41 31
Peak pressure
PCD drainage 1L
PCD drainage 1L
PCD drainage 1L
PCD 4 sites , drainage amount 3 L

9. APCT HD #7, HD #18
HD #13, #18, #19
 PCD reposition 시행

10. Abdominal compartment syndrome in severe acute pancreatitis
Few cases reported up to 22 in the literature
Multi-organ failure arising from elevation in intra-abdominal pressure (>20mmHg)
Intra-abdominal hypertension (>12mmHg)
Reduces blood flow to abdominal organs and impairs pulmonary, cardiovascular, renal, and gastro-intestinal (GI) function, causing multiple organ dysfunction syndrome and death
Caused by
Pancreatic inflammation
Retroperitoneal edema
Peripancreatic fluid collection
Intestinal ileus
Aggressive fluid resurcitation

11. Abdominal compartment syndrome in severe acute pancreatitis
Diagnosis
Bladder pressure monitoring
Abdominal CT
Thickened bowel wall
Increased AP to transverse abdominal diameter
Renal or IVC compression by retroperitoneal exudatesbEarlier decompression procedure
Treatment
Non-operative medical management
Operative decompression

12. Cheatham ML. Nonoperative management of intraabdominal hypertension and abdominal compartment syndrome. World J Surg 2009;33:
^ De Keulenaer BL, De Waele JJ, Malbrain ML. Nonoperative management of intra-abdominal hypertension and abdominal compartment syndrome: evolving concepts. The American surgeon 2011;77 Suppl 1:S34-41.
^ [1] WSACS.org