Experience in the Surgical Management of Abdominal Compartment Syndrome in the Hospital Occidente de Kennedy

Abstract

The abdominal compartment syndrome (ACS) is the result of various physiological alterations produced by an abnormal increase of the intra-abdominal pressure. Some of these patients will undergo a surgical procedure for its management. Methods: This is a retrospective case series of 28 patients with ACS who required surgical treatment at the Hospital Occidente de Kennedy between 1999 and 2003. We assessed retrospectivelythe behavior of McNelis’s equation for predictionof the development of the ACS. Results: The leading cause of ACS in our study was intraabadominalinfection (n=6 21,4%). Time elapsed between diagnosis and surgical decompression was less than 4 hours in 75% (n=21) of the cases.The variables that improved significantly after the surgical decompression were CVP (T: 4,0 p: 0,0001), PIM (T: 2,7; p: 0,004), PIA (T1,8; p:0,034) and Urine Output (T:-2,4; p:0,02). The values of BUN, Creatinine and the cardiovascularinstability did not show improvement. The ICU and hospital length of stay were 11 days (SD: 9) and 18 days (SD13) respectively. Globalmortality was 67,9% (n=19) and mortality directly attributable to the syndrome was 30% (n=8). The behavior of the McNelis’s equation was erratic. Conclusions: The demographic characteristicsas well as disease processes associated with ACS are consistent with the literature. The associationbetween physiological variables and ACS is heterogeneous between patients. Mortalityrates attributable to ACS in our institution are within the range described world-wide. The behavior of the McNelis’s equation seems to depend greatly upon fluid balance.

Keywords

• abdominal compartment syndrome
• intra-abdominal pressure
• surgical decompression
• laparotomy