Mesenteric ischemia, intra-abdominal hypertension,and the abdominal compartment syndrome

Kirkpatrick, Andrew W.; McBeth, Paul B.; Ball, Chad G.; Ejike, J. Chiaka; laet, Inneke E. De; Nickerson, Duncan

doi:10.4172/plastic-surgery.1000950

Cited by 4 publications

(4 citation statements)

References 20 publications

(22 reference statements)

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“…[30,31,40,41] Intestinal mucosal damage due to mesenteric ischemia resulting from intra-abdominal hypertension leads to bacterial translocation and triggers multiple organ failure. [30,31,[39][40][41][42][43] IAP magnitude refl ects the cumulative effect of physiopathological impairments occurring after MAS. [23,24,37] For this reason, IAP adds specifi city to the model and makes it recommendable for prediction of postoperative death in MAS patients, even though on its own, it is not comprehensive.…”

Section: Discussionmentioning

confidence: 99%

Predicting Abdominal Surgery Mortality: A Model Based on Intra-abdominal Pressure

2017

MEDICC Review

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INTRODUCTION Early assessment of prognosis following major abdominal surgery is associated with decreased risk of complications and death. While scoring systems are useful in this regard, there is no index that enables comprehensive individual patient assessment and is also applicable in ICUs with limited resources.OBJECTIVES Demonstrate that a model based on intra-abdominal pressure is effective in predicting death after major abdominal surgery.METHODS A prospective observational study was done of 300 postabdominal-surgery patients admitted to the ICU of a university hospital affi liated with the Ge neral Calixto García Medical Faculty, in January 2008 through January 2010. Patients were randomly assigned (2:1) to two groups: test and validation. The independent variable was vital status at discharge (alive or deceased); independent variables were age, sex, malignancy, APACHE II score and intra-abdominal pressure. In the test group, three mathematical models were fi t to predict death (APACHE II, intra-abdominal pressure, and APACHE II plus intraabdominal pressure), which were later validated in the second group. Each model's capacity to discriminate between living and deceased was evaluated according to sensitivity and specifi city of receiver operating characteristic curves. Calibration was assessed with the Hosmer-Lemeshow goodness-of-fi t test and comparison of receiver operating characteristic curves by chi-square test of homogeneity. Each patient was followed until hospital discharge or death. RESULTSThe three mortality prediction models displayed excellent calibration and discrimination, very similar predictive power, and no differences among their respective areas under the curve (chi square 2.802, p = 0.094). Variables with the most infl uence on probability of death were age, APACHE II score and intra-abdominal pressure. CONCLUSIONSThe three models show good capacity and similar effectiveness to predict death after major abdominal surgery. The model based on intra-abdominal pressure is the most feasible in limited-resource settings.

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Section: Discussionmentioning

confidence: 99%

Predicting Abdominal Surgery Mortality: A Model Based on Intra-abdominal Pressure

2017

MEDICC Review

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“…CT images show a whirl pattern due to a dilated SC around its mesocolon and vessels and a bird's-beak appearance of the colonic segments. Failure to recognize it early can lead to mesenteric ischemia, bowel wall perforation, gangrene, and resulting peritonitis, and increasing intra-abdominal pressure (IAP) leads to abdominal compartment syndrome (ACS) [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Abdominal Compartment Syndrome (ACS) With Sigmoid Volvulus (SV): Lost Hours Are Lost Lives

Marin¹,

Hechter²,

Prasad³

et al. 2023

Cureus

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Normal intra-abdominal pressure (IAP) ranges from 0 to 5, and abdominal compartment syndrome (ACS) occurs when a sustained IAP >20 mmHg causes organ dysfunction. ACS mainly occurs in patients who are critically ill. It occurs due to an injury or disease in the abdomen or pelvic area, including trauma, abdominal surgery, acute pancreatitis, pancreatic ileus, volvulus, fecal impaction, and ruptured abdominal aortic aneurysm. If not recognized early, ACS leads to multiorgan dysfunction, shock, and sepsis and has high morbidity and mortality. Our patient was brought to the emergency department (ED) following cardiac arrest and resuscitation and was diagnosed with sigmoid volvulus (SV) and ACS. SV is seen in older men, and its presentation is often insidious and leads to bowel gangrene and ACS. The patient's delay in presenting to the hospital and the severity of his condition leads to a poor outcome despite surgery. A delay in recognizing ACS can lead to a worse outcome.

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“…Elevated IAP uplifts the diaphragm, resulting in insufficient pulmonary ventilation and dysfunction. Finally, excessive IAP compresses the abdominal capillary bed and causes a decrease in the returned blood volume, thereby leading to circulatory failure [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Management of Incarcerated Indirect Hernia in Pediatric Patients with Intra-abdominal Hypertension: A Retrospective Study

Wenyan

Chen

Lei

et al. 2021

Preprint

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Background: Intra-abdominal hypertension (IAH) is a critical condition that can be induced by incarcerated indirect inguinal hernia (IIIH). There are currently no specific guidelines for laparotomy in children. To determine whether laparotomy should be performed during the management in pediatric patients with IIIH combined with IAH.Methods: This is a retrospective study of pediatric patients with IIIH and IAH who were admitted and treated at the Department of General Surgery of Jiangxi Provincial Children’s Hospital from 01/2010 to 06/2020. The patients were divided into Group A (intra-abdominal pressure (IAP) of 10-20 mmHg) and Group B (IAP ≥ 21 mmHg). Each group was further subdivided into Group 1 (decompression) and Group 2 (no decompression) depending on whether decompressive laparotomy was performed or not. The last follow-up was three months after discharge.Results: A total of 49 patients were enrolled, and divided into group A1 (n = 21), A2 (n = 10), B1 (n = 4), B2 (n = 14). Compared with patients in group A1, those who had decompression (group A2) has longer hospital stay (7.5 ± 1.9 vs. 5.2 ± 2.1, p = 0.01), higher 24h-postoperative IAP (11.3 ± 2.4 vs 9.5 ± 2.1, p = 0.03), longer PICU stay (2.1 ± 0.9 vs. 1.1 ± 0.5, p = 0.001), and more perioperative complications. In contrast, among patients with IAP higher than 20mmHg, those who had decompresion via laparotomy (group B2) had comparable hospital stay (7.1 ± 5.1 vs. 8.5 ± 4.1, p = 0.57), a shorter PICU stay (3.0 ± 1.4 vs. 4.7 ± 1.3, p = 0.04) and lower mortality rate (7.1% vs. 50%, p = 0.04) than patients in group B1.Conclusions: The selection of appropriate surgical methods according to IAP and based on clinical diagnosis can relieve the pain of children, shorten hospital stay, and reduce the mortality rate.

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Mesenteric ischemia, intra-abdominal hypertension,and the abdominal compartment syndrome

Cited by 4 publications

References 20 publications

Predicting Abdominal Surgery Mortality: A Model Based on Intra-abdominal Pressure

Predicting Abdominal Surgery Mortality: A Model Based on Intra-abdominal Pressure

Abdominal Compartment Syndrome (ACS) With Sigmoid Volvulus (SV): Lost Hours Are Lost Lives

Management of Incarcerated Indirect Hernia in Pediatric Patients with Intra-abdominal Hypertension: A Retrospective Study

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