Abdominal compartment syndrome

Sindrom abdominalnog kompartmenta je disfunkcija jednog ili više organskih sustava uzrokovana intraabdominalnom hipertenzijom, odnosno povišenim tlakom u abdominalnoj šupljini. Pogođen može biti gotovo svaki organski sustav te može nastupiti smanjenje srčane funkcije, venskog priljeva u srce i perfuzije abdominalne viscere, hipoksemija, hiperkapnija, zatajenje bubrega i povišenje intrakranijalnog tlaka. Dijagnoza sindroma abdominalnog kompartmenta postavlja se mjerenjem intraabdominalnog tlaka, najčešće indirektno, korištenjem intravezikalnog katetera. Simptomi, znakovi i radiološke slikovne metode nedovoljne su za postavljanje dijagnoze. Liječenje se sastoji od pažljivog praćenja, suportivnih mjera i kirurške dekompresije. Kirurška dekompresija je definitivna terapijska metoda i ne smije se odgađati u pacijenata s razvijenim sindromom abdominalnog kompartmenta. Nakon dekompresije medijalnom laparotomijom, abdomen se održava otvorenim dok se intraabdominalni tlak ne smanji. Kako bi se reducirao posljedični gubitak tekućine i proteina, stvaranje fistula te gubitak domene, abdomen se privremeno zatvara raznim tehnikama. One uključuju zatvaranje zakrpom, abdominalnim spremnikom te zatvaranje pomoću sistema za primjenu negativnog tlaka. Navedene tehnike imaju određene prednosti i nedostatke, a najbolja se pokazala kombinacija Wittmanove zakrpe i sistema za primjenu negativnog tlaka. Dok se abdomen održava otvorenim, pacijenta treba pažljivo monitorirati u jedinici intenzivne skrbi i reevaluirati u kirurškoj sali, po potrebi više puta. Definitivno zatvaranje abdomena treba učiniti što prije, čim se intraabdominalna hipertenzija razriješi. Idealan način je primarno fascijalno zatvaranje, ali ako ono nije izvedivo, može se učiniti funkcionalno zatvaranje, odnosno postavljanje kirurške mrežice inlay tehnikom. Funkcionalno zatvaranje omogućava premoštenje defekta abdominalnog zida i pospješuje nastanak novog vezivnog tkiva fascije. Ako se rubovi fascije ni na koji način ne mogu funkcionalno zatvoriti, preostaje učiniti planiranu abdominalnu herniju. Ishodi su najbolji nakon primarnog fascijalnog zatvaranja. Mortalitet pacijenata koji su razvili sindrom abdominalnog kompartmenta u literaturi se kreće između 40% i 100%.Abdominal compartment syndrome refers to organ dysfunction caused by intra-abdominal hypertension, meaning high pressure inside the abdominal cavity. Nearly every organ system can be affected, leading to impaired cardiac function, decreased venous return, hypoxemia, hypercarbia, renal failure, diminished splanchnic perfusion, and elevated intracranial pressure. The diagnosis of abdominal compartment syndrome requires intra-abdominal pressure measurement. Indirect measurement of intravesical pressure via a urinary catheter is the usual method. Symptoms, physical signs, and imaging findings are insufficient as diagnostic tools. Management consists of careful observation, supportive care, and surgical decompression. Surgical decompression of the abdominal cavity is considered definitive management and shouldn't be delayed in patients with developed abdominal compartment syndrome. Following decompression via median laparotomy, an open abdomen is maintained until intra-abdominal pressure normalizes. To reduce fluid and protein losses, fistula formation and loss of domain, the abdomen is temporarily closed using various techniques. They include patch closure, silo closure, and negative pressure systems. Each mentioned technique has some advantages and disadvantages, but Wittman patch and negative pressure system combination seems to be the best choice. During open abdomen maintenance, the patient has to be closely monitored in an intensive care unit and his condition reevaluated inside the operating room as many times is necessary. Definitive closure of the abdomen should be performed as soon as possible when intra-abdominal hypertension is successfully treated. Primary fascial closure is ideal, but if it is not feasible, functional closure can be performed using a surgical mesh inlay technique. Functional closure enables abdominal defect bridging and generation of new fascial tissue. If the gap between the fascial edges is too wide for a functional closure, planned ventral hernia is the only option. Patient outcomes are best with primary fascial closure. Mortality for patients who developed abdominal compartment syndrome ranges between 40% and 100%