Abdominal compartment syndrome.

French physicians dealing with abdominal emergencies are not very familiar with the abdominal compartment syndrome (ACS). Increased abdominal pressure has deleterious consequences on local (intestine, liver, kidney) circulati on, leading to death in the absence of correct treatment. Abdominal trauma and ruptured aortic aneurism are the main causes of ACS. Clinical presentat ion may be misleading: respiratory failure, oliguria or circulatory symptom s are often predominant. Abdominal palpation is inefficient for evaluating intra-abdominal pressure (IAP); only measurement of cystic pressure allows precise evaluation of IAP. Abdominal decompression is the treatment of choice. It must be performed as soon as IAP exceeds 25 mmHg. The procedure may be risky with a high incide nce of severe complications when ischaemic territories are reperfused. Rece nt data underline the importance of compensation of hypovolemia before deco mpression. Abdominal closure may necessitate various techniques (aponevroto my, Bogota bags, etc.). At any rate, IAP must remain low at the end of the procedure. In case of suspicion of ACS, early measurement of IAP is mandatory. If pres sure is over 25 mmHg, a decompressive procedure must be initiated. (C) 2001 Editions scientifiques et medicales Elsevier SAS.