Abdominal compartment syndrome in severe acute pancreatitis: an indication for a decompressing laparotomy?
BACKGROUND
The currently prevailing paradigm calls for non-operative management of severe acute pancreatitis for as long as there is no evidence of infection. Our purpose in presenting this anecdotal experience is to propose that there is a subset of patients who may need a laparotomy in the absence of infection in order to decompress a clinically significant abdominal compartment syndrome (ACS), which is associated with the acute pancreatitis.


METHODS
We present our recent experience with three patients suffering from severe acute pancreatitis. The three developed intra-abdominal hypertension (IAHT) and clinical ACS, which necessitated abdominal decompression and a laparostomy. One patient survived.


CONCLUSIONS
The notion that patients with severe acute pancreatitis may develop ACS, which necessitate emergency abdominal decompression, has been ignored by current surgical literature. Only increased awareness to the syndrome of IAHT-ACS in acute pancreatitis and transvesical measurement of intra-abdominal pressure will reveal its prevalence and significance.
Gecelter
Gary
G
Department of Surgery, New York Methodist Hospital, Cornell University Medical College, Brooklyn, N.Y., USA.
Fahoum
Bashar
B
Gardezi
Syed
S
Schein
Moshe
M
D000208:Acute Disease; D000328:Adult; D000368:Aged; D003161:Compartment Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D017809:Fatal Outcome; D005260:Female; D005313:Fetal Death; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000601:surgery*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome