Abdominal compartment syndrome (ACS) refers to end organ dysfunction caused by intra-abdominal hypertension (IAH) (Gestring, 2023). ACS is defined as a sustained intra-abdominal pressure greater than 20 mm Hg that is associated with new end-organ dysfunction (Gestring, 2023). The causes for ACS include traumatic injury, severe burns, post liver transplant patients, bowel obstruction, massive ascites, intra-abdominal surgery, intra or retroperitoneal hemorrhage, and edema secondary to massive volume/blood resuscitation (Klingensmith & Wise, 2019). When in intra-abdominal pressure rises, venous return is compromised causing impaired cardiac and pulmonary function, renal impairment, decreased gut perfusion and increased intracranial pressure (Gestring, 2023).

Signs and symptoms of ACS

Most patients who develop ACS are critically ill and likely unable to communicate, however those who can communicate may report weakness, abdominal pain/bloating, and dyspnea (Gestring, 2023). Physical exam findings of ACS include tensely distended abdomen, progressive oliguria, increased ventilatory requirements, hypotension, tachycardia, elevated jugular venous pressure, peripheral edema and abdominal tenderness (Gestring, 2023).

Diagnosis of ACS

ACS is diagnosed with measurement of intra-abdominal pressure, which should always be performed even if there is low evidence of suspicion based on clinical findings. Measurement of bladder pressure is the standard method of screening for IAH or ACS. Bladder pressure is measured using a foley catheter; the pressure is measured with the patient supine, at end-expiration after ensuring abdominal muscle contractions are absent (use of chemical paralytics may be necessary). Measurement of 20 mm Hg to 30 mm HG with evidence of end-organ dysfunction is diagnostic for ACS and requires prompt intervention (Klingensmith & Wise, 2019).

Management of ACS

Management of ACS includes supportive care and temporizing measures with patient positioning, pain control and sedation, chemical paralysis, nasogastric decompression, evacuation of ascites/hematoma, or bladder or bowel decompression (Klingensmith et al., 2008). Surgical decompression is typically indicated for patients with intra-abdominal pressure > 20 mm Hg. Surgical decompression can be performed at the bedside in the intensive care unit if the patient is unstable, or in the operating room. The standard technique is a decompressive laparotomy (Gestring, 2023).  Most often when surgical decompression is performed for ACS, an open abdomen is maintained with temporary abdominal wall closure with delayed primary closure once edema improves (Klingensmith & Wise, 2019).

ACS is a life-threatening complication with high morbidity and mortality. Failure to recognize ACS may lead to multisystem organ failure and death.

References:
Gestring, M. (2023, June 20). Abdominal compartment syndrome in adults. UpToDate. https://www.uptodate.com/contents/abdominal-compartment-syndrome-in-adults

Klingensmith, M., & Wise, P. (2019). The Washington Manual of Surgery, 8^th edition. Wolters Kluwer.

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