Interventional Treatment of Abdominal Compartment Syndrome during Severe Acute Pancreatitis: Current Status and Historical Perspective

Author:

Radenkovic Dejan V.1,Johnson Colin D.2,Milic Natasa3,Gregoric Pavle4,Ivancevic Nenad4,Bezmarevic Mihailo5,Bilanovic Dragoljub6,Cijan Vladimir7,Antic Andrija1,Bajec Djordje1

Affiliation:

1. Clinic for Digestive Surgery, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

2. Department of Surgery, University Hospital Southampton, Southampton, UK

3. Institute for Biostatistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

4. Clinic for Emergency Surgery, Emergency Center, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

5. Clinic for Surgery, Military Medical Academy, Belgrade, Serbia

6. Clinic for Surgery, Clinical Center “Bezanijska Kosa”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

7. Clinic for Surgery, Clinical Center “Zvezdara”, Belgrade, Serbia

Abstract

Abdominal compartment syndrome (ACS) in patients with severe acute pancreatitis (SAP) is a marker of severe disease. It occurs as combination of inflammation of retroperitoneum, visceral edema, ascites, acute peripancreatic fluid collections, paralytic ileus, and aggressive fluid resuscitation. The frequency of ACS in SAP may be rising due to more aggressive fluid resuscitation, a trend towards conservative treatment, and attempts to use a minimally invasive approach. There remains uncertainty about the most appropriate surgical technique for the treatment of ACS in SAP. Some unresolved questions remain including medical treatment, indications, timing, and interventional techniques. This review will focus on interventional treatment of this serious condition. First line therapy is conservative treatment aiming to decrease IAP and to restore organ dysfunction. If nonoperative measures are not effective, early abdominal decompression is mandatory. Midline laparostomy seems to be method of choice. Since it carries significant morbidity we need randomized studies to establish firm advantages over other described techniques. After ACS resolves efforts should be made to achieve early primary fascia closure. Additional data are necessary to resolve uncertainties regarding ideal timing and indication for operative treatment.

Publisher

Hindawi Limited

Subject

Gastroenterology,Hepatology

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