Secondary abdominal compartment syndrome is a highly lethal event.
BACKGROUND
Recent reports have described resuscitation-induced, "secondary" abdominal compartment syndrome (ACS) in trauma patients without intra-abdominal injuries. We have diagnosed secondary ACS in a variety of nontrauma as well as trauma patients. The purpose of this review is to characterize patients who develop secondary ACS.


METHODS
Our prospective ACS database was reviewed for cases of secondary ACS. Physiologic parameters and outcomes were recorded. Data are expressed as mean +/- SEM.


RESULTS
Fourteen patients (13 male, aged 45 +/- 5 years) developed ACS 11.6 +/- 2.2 hours following resuscitation from shock. Eleven (79%) had required vasopressors; the worst base deficit was 14.1 +/- 1.9. Resuscitation included 16.7 +/- 3.0 L crystalloid and 13.3 +/- 2.9 red blood cell units. Decompressive laparotomy improved intra-abdominal, systolic, and peak airway pressures, as well as urine output; however, mortality was 38% among trauma and 100% among nontrauma patients.


CONCLUSIONS
Secondary ACS may be encountered by general surgeons in a variety of clinical scenarios; resuscitation from severe shock appears to be the critical factor. Early identification and abdominal decompression are essential. Unfortunately, in our experience, this is a highly lethal event.
Biffl
W L
WL
Department of Surgery, Box 0206, Denver Health Medical Center, 777 Bannock St., Denver, CO 80204-4507, USA. wbiffl@dhha.org
Moore
E E
EE
Burch
J M
JM
Offner
P J
PJ
Franciose
R J
RJ
Johnson
J L
JL
D000005:Abdomen; D003161:Compartment Syndromes / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012151:Resuscitation / Q000009:adverse effects*; D012769:Shock / Q000628:therapy; D016896:Treatment Outcome