[Early diagnosis and risk factors associated with abdominal compartment syndrome].
BACKGROUND
Abdominal compartment syndrome (ACS) is a clinical entity that develops after sustained and uncontrolled intraabdominal 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.


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 IIIIV (group II). All group II patients were treated with abdominal decompression. The most common clinical entities associated were closed abdominal trauma (28%), hernias (15%), intestinal occlusions: (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.
Flores-Alvarez
Efrén
E
Departamento de Cirugía, Hospital de Especialidades Miguel Hidalgo, ISEA, Galeana Sur 465, Col. Centro, 20000 Aguascalientes, Aguascalientes, México. efflorez@hotmail.com
Avila-Cuevas
Gloria Esther
GE
de la Torre-González
José Cruz
JC
Rivera-Barragán
Virgilio
V
López-Rodríguez
Jorge Luis
JL
Reynoso-Talamantes
David
D
D000005:Abdomen; D000007:Abdominal Injuries / Q000150:complications; D000328:Adult; D003161:Compartment Syndromes / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors