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

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

3. 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”

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

5. 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 ,….

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

7. 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.

8. 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

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

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

11. Abdominal Compartment Syndrome

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

13. 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.

14. Abdominal Compartment Syndrome

15. 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

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