Fact-sheet: Abdominal compartment syndrome


Updated on 09/25/2024 at 5:14 PM

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Definition

Abdominal compartment syndrome is defined by a rapid and sustained increase in intra-abdominal pressure > 20 mmHg, without the possibility of compensatory mechanisms, associated with organ failure, often with a fatal outcome.

Clinical features

Rapid and sustained increase in intra-abdominal pressure that may be secondary to:

  • an acute intra-abdominal condition: polytrauma, acute pancreatitis, bowel obstruction, ruptured abdominal aortic aneurysm...
  • decreased abdominal compliance: major burns, parietal edema following massive fluid resuscitation
  • a multifactorial origin combining these different mechanisms

Affects 2-6% of critically ill patients.

  • Signs of organ failure.
  • Abdominal distension.

CT

Pathologic abdominal distension:

  • height ratio HR at the level of the third portion of the duodenum >0.52: distance from the posterior wall of D3 to the linea alba / distance from the posterior fascia to the linea alba, excluding subcutaneous fat. Most specific sign

Ratio des hauteurs syndrome du compartiment abdominal

  • round belly sign RBS = AP diameter of the abdomen / transverse diameter of the abdomen > 0.8 at the level of the crossing between the left renal vein and the aorta, excluding subcutaneous fat

Round belly sign syndrome du compartiment abdominal

Associated signs:

  • IVC compression: slit-like lumen < 3mm
  • Kidney compression: loss of anterior renal convexity
  • elevation of the diaphragmatic domes, with the dome above T10
  • signs of intra-abdominal organ hypoperfusion
  • signs related to the causative condition

Management

Medical treatment of the cause of abdominal hyperpressure

Diagnostic confirmation by intravesical pressure measurement

Emergency decompressive abdominal surgery

Differential diagnosis

Chronic intra-abdominal hyperpressure: ascites, pregnancy, obesity...