2005, Number 3
Cir Cir 2005; 73 (3)
Flores-Álvarez E, Ávila-Cuevas GE, de la Torre-González JC , Rivera-Barragán V, López-Rodríguez JL, Reynoso-Talamantes D
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ABSTRACTIntroduction: Abdominal compartment syndrome (ACS) is a clinical entity that develops after sustained and uncontrolled intra-abdominal hypertension (IAHT). The ACS is clinically characterized by a massively distended abdomen and respiratory, cardiovascular, neurologic, and renal dysfunction.
Objective: The goal of this study was to demonstrate the benefit of early diagnosis of intra-abdominal hypertension and ACS and to identify risk factors associated with mortality.
Material and methods: We used a prospective study that included all patients admitted to Hospital de Especialidades Miguel Hidalgo with known ACS risk factors between January 2002 and December 2003. All patients were submitted to systematic measurements of intra-abdominal pressure (IAP). Those patients with grade III-IV IAHT were treated with decompressive laparotomy.
Results: Included in the study were 32 patients (23 males and 9 females). Mean age was 45.0 ± 18.34 years. Twenty three patients developed IAHT grade I-II (group I) and nine developed grade III-IV (group II). All group II patients were treated with abdominal descompresion. The most common clinical entities associated were closed abdominal trauma (28%), hernias (15%), intestinal occlusion (12.5%), acute pancreatitis (9.4%) and mesenteric ischemia (6.3%). Grade III-IV IAHT was statistically associated with reoperation (p = 0.038), acidosis (p = 0.003), anuria (p 0.001) and sustained arterial hypotension (p = 0.004). The significant variables associated to mortality were anuria (p = 0.024) and grade III-IV IAHTA (0.017).
Conclusions: It is possible to make an early diagnosis of IAHT and ACS with an indirect measurement of IAP. The most important factors related to mortality are anuria and IAHT.