Abdominal compartment syndrome: avoidance and treatment

Abdominal compartment syndrome is defined by increased intraabdominal press ure above 20 mmHg with increased pulmonary peak pressure and oliguria. in p rimary abdominal compartment syndrome the increased intraabdominal pressure is caused directly by peritonitis, ileus or abdominal and pelvic trauma. S econdary compartment syndrome is a result of forced closure of the abdomina l wall after abdominal surgery. The effects are decreased cardiac output, p ulmonary atelectasis, oliguria to anuria and hepatic as well as intestinal reduction of perfusion. Effective monitoring is done by standardised measur ing of urinary bladder pressure. Normal values are between 0 and 7 cm H2O, after elective laparotomies 5-12 cm H2O. Above 25 cm H2O they are definitel y pathological. For the prevention and therapy of manifested abdominal comp artment syndrome the application of a laparostomy using a resorbable mesh i s recommended. Between 1988 and 1999 we applied a laparostomy to lower the intraabdominal pressure in 377 patients. In 16% of the cases it was indicat ed by primary abdominal compartment syndrome with a bladder pressure of 31 +/- 4 cm H2O preoperatively, which could be lowered to 17 +/- 4 cm H2O by l aparostomy. An early reconstruction of the abdominal wall could be performe d in 18% of the cases. Conclusions: The abdominal compartment syndrome is a n often underestimated problem in abdominal surgery involving multiple orga n systems. The temporary laparostomy lowering intraabdominal pressure rathe r than a forced closure of the abdominal wall should be used in ail circums tances.