What Is Abdominal Compartment Syndrome?

Abdominal compartment syndrome (ACS), also known as abdominal fascial compartment syndrome and abdominal space syndrome, is caused by non-physiological, progressive, and sharp increases in intra-abdominal pressure due to different factors, causing intra-abdominal organs and related extra-abdominal A clinical syndrome of impaired organ system function. However, in some pathological conditions, the intra-abdominal pressure will increase, which will adversely affect the functions of various organs of the human body to a certain extent. After a certain period of time, it will affect the blood flow and functions of multiple organs, and organ insufficiency and even failure may occur. Eventually developed into abdominal compartment syndrome.

Basic Information

Visiting department: Gastroenterology
Common causes: Abdominal wall compliance decreased, gastrointestinal contents increased sharply and other factors.

Common symptoms: High abdominal distension, abdominal pain, or nausea, vomiting, and palpitations.
Contagious: no

Causes of abdominal compartment syndrome

1. Abdominal wall compliance reduces acute respiratory failure, especially with increased intrathoracic pressure. After a period of abdominal fascia closure surgery, the abdominal wall is severely traumatized and centrally obese. Abdominal wall ischemia and edema caused by various causes can make the abdominal wall conform. Sex decreased.
2. The contents of the gastrointestinal tract increase the gastric motility disorder severely, which leads to a severe dilation of the stomach, and paralytic intestinal obstruction causes a large amount of fluid and gas to remain in the intestine.
3 Abdominal contents increase a large amount of ascites, major abdominal surgery, trauma, vascular lesions, liver and spleen rupture or inflammatory lesions causing intra-abdominal bleeding, obstetric hemorrhage, amniotic fluid embolism, severe abdominal infection, abscess, peritonitis, giant abdominal tumor, intra-abdominal organ Severe edema and critical illness after liver transplantation.
4 Increased retroperitoneal volume. Massive retroperitoneal hemorrhage, severe infections, abscesses, huge tumors, severe acute pancreatitis, pelvic fractures, etc., can also rapidly increase intra-abdominal pressure and cause abdominal compartment syndrome.
5. Patients who need resuscitation with a large amount of fluid for various reasons may be too fast and excessively rehydrated, especially when they contain excessive crystals, which can cause a sharp increase in intra-abdominal pressure and thus cause abdominal compartment syndrome.

Clinical manifestations of abdominal compartment syndrome

1. Symptoms are high abdominal distension, abdominal pain, or nausea and vomiting, and palpitations, shortness of breath, chest tightness, tachycardia, shortness of breath, oliguria or anuria.
2. Signs decreased blood pressure, swollen superficial veins, highly swollen abdomen and abdominal wall tension, similar to round abdomen, abdominal tenderness with or without significant tenderness, increased abdominal wall tension or abdominal wall tension, and bowel sounds weakened or disappeared.

Abdominal compartment syndrome

1. The laboratory tests lower blood oxygen partial pressure, central venous pressure, and capillary wedge pressure.
2. Imaging examination (1) X-ray of the chest: suggesting ascites and sacral movement.
(2) B-ultrasound: suggesting ascites and large fluid in the intestine.
(3) CT: a large amount of peritoneal effusion, anteroposterior / transverse diameter of the abdominal cavity 0.8; edema of the intestinal wall thickening; closed abdominal organ space; renal compression or displacement, renal vein or inferior vena cava stenosis intestinal fluid.

Diagnosis of abdominal compartment syndrome

At present, there is no unified diagnostic standard. A clear etiology that induces abdominal compartment syndrome is required. Diagnosis can be made when the intra-abdominal pressure is 2.66 kPa (20 mmHg) and one or more of the following are present.
1. Clinically, there is oliguria or anuria.
2. Shortness of breath or dyspnea, hypoxemia, hypercapnia.
3 The suction pressure is greater than 3.92kPa (40cmH2O).
4 Low blood pressure and fast heart rate.
5. Symptoms eased after a decrease in intra-abdominal pressure.
6. X-ray, B-mode ultrasound, and CT auxiliary examinations revealed signs of sacral movement and ascites.

Treatment of abdominal compartment syndrome

1. Generally support the treatment of bed rest, nutritional support, actively replenish effective circulation, maintain water, electrolyte and acid-base balance, correct hypoproteinemia and anemia, and give sedative and analgesic medications if necessary.
2. Actively treat patients with primary pelvic and abdominal trauma, save lives and actively prepare for surgery, and perform surgical treatment as soon as possible; patients with primary and secondary peritonitis should effectively control infection; in addition to somatostatin in acute severe pancreatitis Or octreotide and other drugs to inhibit pancreatic secretion, but also need to apply drugs that inhibit pancreatic enzyme activity.
3 Gastrointestinal decompression enema and endoscopic decompression are simple and reliable methods for treating mild and moderate intra-abdominal pressure increase. Continuous gastrointestinal decompression, maintaining drainage, and feasibility of anal canal exhaust. In addition, gastrointestinal motility drugs, magnesium sulfate, lactulose and other cathartic agents can be injected into the gastric tube, which can help empty the intestinal contents, reduce intestinal edema, and reduce intestinal pressure; inject microecological preparations to adjust the intestinal flora imbalance Reduces endotoxin production.
4 Surgical treatment The purpose of surgery is to shorten the operation time as much as possible, solve the life-threatening problems, and reduce the intra-abdominal pressure. For patients with obvious accumulation of fluid in the abdominal cavity and retroperitoneum, minimally invasive drainage or open decompression can be performed; for intraabdominal pressure> 3.33kPa (25mmHg) and abnormal physiological indicators, such as oliguria and increased airway pressure, it is feasible to open Abdominal decompression; for patients with intra-abdominal pressure> 4.66kPa (35mmHg), emergency open decompression should be performed.
5. Other treatments (1) Hemofiltration: under the premise of ensuring sufficient capacity, reduce interstitial edema through ultrafiltration; remove inflammatory mediators and reduce the body's inflammatory response.
(2) The method of abdominal puncture is simple and has little trauma, but the decompression effect is not good.

Prevention of abdominal compartment syndrome

Because there is still a certain mortality rate after decompression treatment, prevention of this disease should be strengthened. First of all, we must improve the understanding of abdominal compartment syndrome. For patients with risk factors for increased intra-abdominal pressure, we should closely observe their vital signs, and place and retain the catheter to monitor intra-abdominal pressure. This allows early diagnosis and timely treatment to reduce mortality.