Das abdominelle Kompartment-Syndrom

Zusammenfassung.

Das abdominelle Kompartment wird durch die Bauchdecke, die Rippen, die Wirbelsäule, beide Psoasmuskeln, das Zwerchfell und den Beckenboden begrenzt. Es schließt also das Retroperitoneum mit ein. Anhaltende Druckerhöhungen in diesem Raum können zur Beeinträchtigung der Funktion des Magen-Darmtraktes, der Nieren, des Herz-Kreislaufsystems und der Lungen führen. Diese sind nach Druckentlastung reversibel. Häufige Ursachen für eine intraabdominelle Druckerhöhung sind abdominelle Operationen, Bauchtraumata, diffuse Peritonitis, Aszites und Ödem nach Reanimation. Das Ausmaß der Funktionsstörungen wächst mit steigendem und länger anhaltendem Druck. Die pathophysiologische Situation, in der die intraabdominelle Druckerhöhung unbehandelt zu einem Multiorganversagen führt, wird abdominelles Kompartmentsyndrom genannt. Bei ausbleibendem Erfolg der konservativen Behandlungsmöglichkeiten kann oft nur noch eine operative Dekompression helfen. Anhand tierexperimenteller Untersuchungen und klinischen Erfahrungen lassen sich in Abhängigkeit vom intraabdominellen Druck Empfehlungen zur Therapie geben. Bei entsprechender klinischer Symptomatik sollte der intraabdominelle Druck gemessen werden. Da die Bestimmung des Blaseninnendrucks eine gute Näherung des intraabdominellen Drucks darstellt und ohne großen Aufwand durchführbar ist, können diese Werte problemlos in der medizinische Entscheidungsfindung berücksichtigt werden. Es besteht ein großer Bedarf an kontrollierten Studien, um die klinische Wertigkeit der intraabdominellen Druckerhöhung und des abdominellen Kompartmentsyndroms zu bestimmen.

The Abdominal Compartment Syndrome.

The abdominal compartment is limited by the abdominal wall, Mm. Psoas, vertebral column, diaphragm and the pelvis. Thus the retroperitoneum is included. Elevated intraabdominal pressure may profoundly impair the function of the entire gastrointestinal tract, the cardiovascular, respiratory, and renal system. Reduction of increased intraabdominal pressure may reverse all these adverse effects. The most common causes of elevated intraabdominal pressure are abdominal operations, abdominal trauma, diffuse peritonitis, ascites and peritoneal edema following resuscitation. Excessively increased intraabdominal pressure may result in a total loss of function and may lead to death. Such a condition is called an abdominal compartment syndrome. It usually requires operative decompression. According to animal experiments and clinical experiences suggestions for treatment are given. Diagnostic suspicion of elevated intraabdominal pressure may be confirmed with objective measurements. Since bedside manometry using a Foley catheter provides a valuable estimate of intraabdominal pressure and is easy to perform, intraabdominal pressure values may contribute to medical decision making. At this time there is a great need of controlled clinical trials to point out the importance of increased intraabdominal pressure and the abdominal compartment syndrome.

abdominelles Kompartmentsyndrom - - intraabdomineller Druck - - postoperative Komplikationen - - Dekompression - - Übersicht

Abdominal compartment syndrome - - Intraabdominal pressure - - Postoperative complications - - Decompression - - Review

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