Diagnosis and Choice of a Method of Treatment of Intraabdominal Hypertension and Abdominal Compartment Syndrome

Abstract

BACKGROUND: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) remain a complex problem of abdominal surgery. To date, the pathophysiological mechanisms, methods for determining intra-abdominal pressure (IAP) the frequency of its measurement, and the methods of conservative and surgical more and more researchers consider surgical decompression as a treatment. AIMS: Аnalysis of the results of the implementation of monitoring of intra-abdominal pressure and its impact on the outcomes of treatment of patients with severe acute pancreatitis and acute colon obstruction. MATERIALS AND METHODS: A study of 397 patients with emergency abdominal pathology including 197 with acute obstructive obstruction of the colon (AOOC), 200 severe acute pancreatitis (SAP) was performed. Patients (n=201) were included in the I (main) group, which was carried out using IAP as the main criterion for assessing the patient`s condition and when choosing a method of treatment, in II ― without taking then into account and monitoring. Measurement of IAP, blood lactate was determined primarily, then alternatively 4 to 6 hours. The survey included the study of biochemical indicators, endoscopic methods, visualization (ultrasound scanning, CT of the abdominal cavity organs). RESULTS: In the I group of IAH patients, I and II degrees were in 73.13%, in the II group in 79.5% IAH III and IV degrees, respectively, in 26.87% and 21.5% (p0.05). Measurement of IAP was carried out according to the I.L. Kron method, repeated measurement depending on the degree of IAH after 46 hours, simultaneously, as a predictor of internal ischemia, determined the level of lactate in blood and perfusion abdominal pressure. An algorithm for early diagnosis is suggested excess intraabdominal pressure. For I and II, the degree of IAH was treated with aggressive conservative therapy, with failure of intensive therapy III of IAH degree surgical treatment, with IV degree IAH emergency decompressive laparotomy. In the I group, the mortality was significantly lower than in the II group: IAH at III, with AOOC 27.7% and 50%, respectively (p0.05), at SAP 37.5% and 80% (p0.01), respectively, at IV degree IAH for AOOC 75% and 90% (p0.05), with SAP 75% and 88,8% (p0.05) respectively. CONCLUSIONS: The results of treatment of patients with IAH can be improved by its early diagnosis, intensive, aggressive therapy of IAH IIII degrees. At IAH I, II degrees conservative treatment is shown, persistent aggressive conservative treatment should be performed at IAH III degree, if it is unsuccessful and IV degree of IAH, an emergency decompressive laparotomy should be performed.