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DOI: 10.1055/s-2001-16568
J.A.Barth Verlag in Medizinverlage Heidelberg GmbH & Co.KG
Pathophysiologie und Bedeutung des abdominellen Kompartmentsyndroms
Pathophysiology and clinical significance of the abdominal compartment syndromePublication History
Publication Date:
23 August 2001 (online)
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Pathophysiology and clinical significance of the abdominal compartment syndrome
Summary
Different causes, for example posttraumatic and postoperative complications, can lead to an elevated intra-abdominal pressure. Increased intraabdominal pressure effects cardiovascular, pulmonary and renal systems. The abdominal compartment syndrome can be defined as organ failure caused by an increased intra-abdominal pressure. Clinically the syndrome is characterised by a tensely distended abdomen, oliguria or anuria and/or inadequate ventilation. Early decompression by simple laparotomy and delayed closure is the treatment of choice. If untreated the abdominal compartment syndrome is lethal. Even treated it has a high morbidity and mortality as shown in our series where 2 out of 7 patients with this syndrome died despite surgical decompression.
Zusammenfassung
Posttraumatische und postoperative Komplikationen können Ursache eines pathologisch erhöhten intraabdominellen Druckes sein. Dieser führt zu kardiovaskulären, pulmonalen und renalen Störungen. Entsteht aufgrund des erhöhten intraabdominellen Druckes ein Organversagen, wird von einem abdominellen Kompartmentsyndrom gesprochen. Die häufigsten klinische Zeichen dieses Syndromes sind ein geblähtes Abdomen, Oligurie bis Anurie und die Ateminsuffizienz. Ohne Behandlung verläuft dieses Syndrom meistens letal. Auch bei rechtzeitiger Behandlung sind Morbidität und Letalität hoch. Wir berichten über 7 Patienten mit einem abdominellen Kompartmentsyndrom, die in unserer Klinik diagnostiziert und therapiert wurden. Trotz adäquater chirurgischer Dekompression verstarben 2 der 7 behandelten Patienten. Nur die frühzeitige Erkennung und Behandlung in Form einer chirurgischen Dekompression kann den ansonsten letalen Verlauf verhindern.
Key words
Abdominal compartment syndrome - increased abdominal pressure - postoperative and posttraumatic complications - bladder pressure
Schlüsselwörter
Abdominelles Kompartmentsyndrom - erhöhter intraabdomineller Druck - postoperative und posttraumatische Komplikationen - Harnblasendruck
Literatur
- 1 Barnes G E, Laine G A, Giam P Y, Smith E E, Granger H J. Cardiovascular responses to elevation of intra-abdominal hydrostatic pressure. Am J Physiol. 1985; 248 R 208-213
- 2 Bendaham J, Coetzee C J, Papagianopoulos C, Muller R. Abdominal compartment syndrome. J Trauma. 1995; 38 152-153
- 3 Bloomfield G L, Dalton J M, Sugerman J S, Ridings P C, Demaria E J, Bullock R. Treatment of intracranial pressure secondary to the acute abdominal compartment syndrome in a patient with combined abdominal and head trauma. J Trauma. 1995; 39 1168-1170
- 4 Bongard F, Pianim N, Dubecz S, Klein S R. Adverse consequences of increased intra-abdominal pressure on bowel tissue oxygen. J Trauma. 1995; 39 519-524
- 5 Burch J M, Moore E E, Moore F A, Franciose R. The abdominal compartment syndrome. Surg Clin North Am. 1996; 76 833-842
- 6 Caldwell C B, Ricotta J J. Evaluation of intra-abdominal pressure and renal hemodynamics. Curr Surg. 1986; 43 495-498
- 7 Cullen D J, Coyle J P, Teplick R, Long M C. Cardiovascular, pulmonary, and renal effects of massively increased intra-abdominal pressure in critically ill patients. Crit Care Med. 1989; 17 118-121
- 8 Daly R C, Mucha P, Farnell M B. Abdominal reexploration for increased intraabdominal pressure and acute oliguric renal failure. Contemp Surg. 1989; 35 11-18
- 9 Diebel L N, Dulchavsky S A, Brown W J. Splanchic ischemia and bacterial translocation in the abdominal compartment syndrome. J Trauma. 1996; 40 178
- 10 Durham R, Neunaber K, Vogler G, Shapiro M, Mazuski J. Right ventricular end-diastolic volume as a measure of preload. J Trauma. 1995; 39 218-223
- 11 Eddy V, Nunn C, Morris J A. Abdominal compartment syndrome. The Nashville experience. Surg Clin North Am. 1997; 77 801-812
- 12 Eleftheriadis E, Kotzampassi K, Botsios D, Tzartinoglou E, Farmakis H, Dadoukis J. Splanchnic ischemia during laparoscopic cholecystectomy. Surg Endosc. 1996; 10 324-326
- 13 Eleftheriadis E, Kotzampassi K, Papanotas K, Heliadis N, Sarris K. Gut ischemia, oxidative stress, and bacterial translocation in elevated abdominal pressure in rats. World J Surg. 1996; 20 11-16
- 14 Emerson H. Intra-abdominal pressures. Arch Intern Med. 1911; 7 754-784
- 15 Fabian T C, Croce M A, Pritchard F E, Minard G, Hickerson W L, Howell R L. et al . Planned ventral hernia. Staged management for acute abdominal wall defect. Ann Surg. 1994; 219 643-653
- 16 Feliciano D V, Burch J M. Towel clips, silos, and heroic forms of wound closure. Adv Trauma Crit Care. 1991; 6 231-250
- 17 Iberti T J, Kelly K M, Gentilli D R, Hirsch S, Benjamin E. A simple technique to accurately determine intra-abdominal pressure. Crit Care Med. 1987; 15 1140-1142
- 18 Ivatury R R, Diebel L, Porter J M, Simon R J. Intra-abdominal hypertension and the abdominal compartment syndrome. Surg Clin North Am. 1997; 77 783-800
- 19 Kashtan J, Green J F, Parsons E Q, Holcroft J W. Hemodynamic effects of increased abdominal pressure. J Surg Res. 1981; 30 249-255
- 20 Obeik F, Saba A, Fath J, Guslits B, Chung R, Sorensen V. et al . Increases in intra-abdominal pressure affect pulmonary compliance. Arch Surg. 1995; 130 544-547
- 21 Overholt R H. Intraperitoneal pressure. Arch Surg. 1931; 22 691-703
- 22 Platell C, Hall J, Dobb G. Impaired renal function due to raised intrabdominal pressure. Intensive Care Med. 1990; 16 328-329
- 23 Richards W O, Scovill W, Shin B, Reed W. Acute renal failure associated with increased intra-abdominal pressure. Ann Surg. 1983; 197 183-187
- 24 Ridings P C, Bloomfield G L, Blocher C R, Sugerman H J. Cardiopulmonary effects of raised intra-abdominal pressure before and after intravascular volume expansion. J Trauma. 1995; 39 1071-1075
- 25 Savino J A, Cerabona T, Agarwal N, Byrne D. Manipulation of ascitic fluid pressure in cirrhotics to optimize hemodynamic and renal function. Ann Surg. 1988; 208 504-509
- 26 Schein M, Wittman D H, Aprahamian C C, Condon R E. The abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure. J Am Coll Surg. 1995; 180 745-753
- 27 Shelly M P, Robinson A A, Hesford J W, Park G R. Haemodynamic effects following surgical release of increased intra-abdominal pressure. Br J Anaest. 1987; 59 800-805
- 28 Thorington J M, Schmidt C F. A study of urinary output and blood-pressure changes resulting in experimental ascites. Am J Med Sci. 1923; 165 880-890
- 29 Van Baardwijk A AW, Grubben A CL, Hoofwijk A GM. Meeting van de intraabdominale druk via de blaascatheter: normaalwaarden en validering. Chirurgendagen Nederlandse vereniging voor Heelkunde, Utrecht 1998; 81 (ISBN: 90-801943-6-0)
- 30 Wildergren J T, Battistella F D. The open abdomen: treatment for intraabdominal compartment syndrome. J Trauma. 1994; 37 158
Dr. A. C.L. Grubben
Abteilung für Chirurgie
Postbus 19032
NL 3001 BA
Rotterdam, Niederlande