Surgical Decompression for Abdominal Compartment Syndrome in Severe Acute Pancreatitis

Mentula, Panu

doi:10.1001/archsurg.2010.132

Cited by 133 publications

(91 citation statements)

References 39 publications

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“…Although surgical decompression results in prompt recovery from ACS, it is associated with a significant morbidity including intraabdominal bleeding, persistent infection, development of post-operative fistulas, and hernias [12].…”

Section: Surgical Treatment Of Abdominal Compartment Syndromementioning

confidence: 99%

Surgery for Acute Pancreatitis

2015

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Surgery for acute pancreatitis has undergone significant changes over the last 3 decades. A better understanding of the pathophysiology has contributed to this, but the greatest driver for change has been the rise of less invasive interventions in the fields of laparoscopy, endoscopy and radiology. Surgery has a very limited role in the diagnosis of acute pancreatitis. The most common indication for intervention in acute pancreatitis is for the treatment of complications and most notably the treatment of infected walled off necrosis. Here, the step-up approach has become established, with prior drainage (either endoscopic or percutaneous) followed by delay for maturing of the wall and then debridement by endoscopic or minimally invasive surgical methods. Open surgery is only indicated when this approach fails. Other indications for surgery in acute pancreatitis are for the treatment of acute compartment syndrome, nono c c l u s i v e i n t e s t i n a l i s c h a e m i a a n d n e c r o s i s , enterocutaneous fistulae, vascular complications and pseudocyst. Surgery also has a role in the prevention of recurrent acute pancreatitis by cholecystectomy. Despite the more restricted role, surgeons have an important contribution to make in the multidisciplinary care of patients with complicated acute pancreatitis.

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Section: Surgical Treatment Of Abdominal Compartment Syndromementioning

confidence: 99%

Surgery for Acute Pancreatitis

2015

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“…All that considered, prompt recognition of failed medical management should lead to timely surgical decompression to ensure favorable outcome (9). The burn patient had severe injuries including inhalational burns complicated by fluid overload as a result of aggressive fluids administration.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Compartment Syndrome in Surgical Patients

Muturi¹,

Ojuka²,

Ndaguatha³

et al. 2018

Ann Afr Surg.

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Background: The deleterious effects of intraabdominal hypertension and abdominal compartment syndrome, affect almost every system. Patients at risk are the critically ill, in whom it leads to altered organ perfusion and end organ dysfunction/failure. The five cases reported highlight the diagnostic and management challenges. Case Presentation: Five patients with variable degrees of multiple organ dysfunction/failure as evidenced by derangements in laboratory and clinical parameters are presented. Non-surgical interventions including insertion or repositioning of nasogastric tube, insertion of flatus tube, careful titration of IV fluid requirements and appropriate adjustments of ventilator setting were instituted. All five did not respond to initial management and decompressive

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“…A retrospective series of ACS in severe acute pancreatitis also indicates decreased mortality in patients undergoing early operation. Mentula et al [51] analysed 26 cases of ACS in severe acute pancreatitis treated with surgical decompression in a tertiary care hospital [51]. Decreased mortality was demonstrated with surgery within 4 days from disease onset (18% vs. 100%).…”

Section: Managementmentioning

confidence: 99%

Intra-abdominal hypertension and abdominal compartment syndrome in acute pancreatitis, hepato-pancreato-biliary operations and liver transplantation

Bressan

Ball

2017

Anaesthesiol Intensive Ther

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Intra-abdominal hypertension, even preceding the onset of abdominal compartment syndrome, is still recognized as an adverse prognostic factor. Unfortunately, most of the current supporting evidence within the critical care environment remains observational in nature. In acute pancreatitis, an active role for intra-abdominal hypertension early in the disease process follows a strong intuitive basis, and it is corroborated by preliminary evidence from animal models. Additional studies are needed to better characterize the optimal fluid resuscitation strategy, as well as the importance of intra-abdominal hypertension as an early therapeutic target. All critically ill patients with acute pancreatitis should be considered for routine intra-abdominal pressure monitoring. The prevalence and clinical relevance of intra-abdominal hypertension after elective major abdominal operations are underestimated in the literature. Hepato-pancreato-biliary surgery and liver transplantation represent high-risk surgical subspecialties, and routine intra-abdominal hypertension risk assessment to indicate postoperative intra-abdominal pressure monitoring can be recommended. Conservative management of intra-abdominal hypertension should be promptly initiated upon diagnosis. Although abdominal catheter drainage and decompressive laparotomy may be required in refractory cases based on expert clinical judgment, precise indications and timing are still unclear. Implementation of institutional protocols based on the Abdominal Compartment Society reference standards is crucial to optimize both clinical management and research in this evolving area.

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Surgical Decompression for Abdominal Compartment Syndrome in Severe Acute Pancreatitis

Cited by 133 publications

References 39 publications

Surgery for Acute Pancreatitis

Surgery for Acute Pancreatitis

Abdominal Compartment Syndrome in Surgical Patients

Intra-abdominal hypertension and abdominal compartment syndrome in acute pancreatitis, hepato-pancreato-biliary operations and liver transplantation

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