Zusammenfassung
Ein anhaltend erhöhter intraabdomineller Druck kann das kardiovaskuläre System, die
Atmung und Nierenfunktion stören und letztendlich zum Multiorganversagen führen. Dieses
Problem wird vor allem auf chirurgischen Intensivstationen angetroffen und tritt bei
Operationen an Dünn- und Dickdarm, bei abdominellen Gefäßeingriffen und im Gefolge
von Bauchtraumen gehäuft auf. Ein Expertengremium hat die Erhöhung des intraabdominellen
Drucks auf Werte > 20 mmHg in Verbindung mit einer neu aufgetretenen Organdysfunktion
als „abdominelles Compartmentsyndrom” definiert. Diese Krankheitsentität ist in der
Gastroenterologie wenig bekannt, obwohl sie als Komplikation einer endoskopischen
Perforation mit Ausbildung eines Spannungspneumoperitoneums auftreten kann. Mit der
Verbreitung laparoskopischer Prozeduren erscheint es angebracht, auf die Bedeutung
des Druckmonitorings zur Vermeidung dieser potenziell letalen Komplikation zu verweisen.
Abstract
A sustained increase in intra-abdominal pressure may derange cardiovascular haemodynamics,
respiratory and renal functions and finally lead to multi-organ failure. It is primarily
seen in surgical intensive care units and is most frequently associated with small
and large bowel surgery, vascular surgery, and abdominal trauma. An expert panel has
defined elevated intra-abdominal pressure > 20 mmHg in conjunction with newly occurring
organ dysfunction as “abdominal compartment syndrome” (ACS). This entity is not well
recognised in gastroenterology, although ACS may occur as a complication of endoscopic
perforation resulting in tension pneumoperitoneum. With the propagation of laparoscopic
procedures it may be appropriate to emphasise the importance of intra-abdominal pressure
monitoring in order to avoid this potentially lethal complication.
Schlüsselwörter
Kolonoskopie - Perforation - Spannungspneumoperitoneum - abdominelles Compartmentsyndrom
Key words
colonoscopy - perforation - tension pneumoperitoneum - abdominal compartment syndrome
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Prof. Wolfgang Scheppach
Dept. of Medicine II, University of Wuerzburg
Josef-Schneider-Str. 2
97080 Wuerzburg
Phone: ++49/9 31/20 17 01 70
Fax: ++49/9 31/20 13 65 34
Email: w.scheppach@medizin.uni-wuerzburg.de