Intra-abdominal pressure alterations after large pancreatic pseudocyst transcutaneous drainage.
BACKGROUND
Acute pancreatitis leads to abdominal hypertension and compartment syndrome. Weeks after the episodes pancreatic fluids sometimes organize to pseudocysts, fluid collections by or in the gland. Aims of the present study were to evaluate the intra-abdominal pressure (IAP) induced by large pancreatic pseudocysts and to examine the effect of their transcutaneous drainage on IAP.


METHODS
Twenty seven patients with a pancreatic pseudocyst were included. Nine patients with pseudocysts greater than 1l (group A) had CT drainage and eighteen (volume less than 1l) were the control group. The measurements of group A were taken 6 hours before and every morning after the drainage, while for group B, two measurements were performed, one at the day of the initial CT and one 7 days after. Abdominal compliance (Cabd) was calculated. Data were analyzed using student's t-test.


RESULTS
Baseline IAP for group A was 9.3 mmHg (S.D. 1.7 mmHg), while the first post-drainage day (PDD) IAP was 5.1 mmHg (S.D. 0.7 mmHg). The second PDD IAP was 5.6 mmHg (S.D. 0.8 mmHg), the third 6.4 mmH (S.D. 1.2 mmHg)g, the fourth 6.9 mmHg (S.D. 1.6 mmHg), the fifth 7.9 mmHg (S.D. 1.5 mmHg), the sixth 8.2 mmHg (S.D. 1.4 mmHg), and the seventh 8.2 mmHg (S.D. 1.5 mmHg). Group B had baseline IAP 8.0 mmHg (S.D. 1.2 mmHg) and final 8.2 mmHg (S.D. 1.4 mmHg). Cabd after drainage was 185.6 ml/mmHg (SD 47.5 ml/mmHg). IAP values were reduced between the baseline and all the post-drainage measurements in group A. IAPs seem to stabilize after the 5th post-drainage day. Baseline IAP was higher in group A than in group B, while the two values, at day 7, were equivalent.


CONCLUSIONS
The drainage of large pancreatic pseudocyst reduces IAP. Moreover, the IAP seems to rise shortly after the drainage again, but in a way that it remains inferior to the initial value. More chronic changes to the IAP are related to abdominal cavity's properties and have to be further studied.
Papavramidis
Theodossis S
TS
1st Propedeutic Department of Surgery, AHEPA University Hospital, Aristotle's University of Thessaloniki, Macedonia, Greece. papavramidis@hotmail.com
Duros
Vassilis
V
Michalopoulos
Antonis
A
Papadopoulos
Vassilis N
VN
Paramythiotis
Daniel
D
Harlaftis
Nick
N
D000005:Abdomen / Q000503:physiopathology*; D034841:Abdominal Cavity / Q000503:physiopathology; D000208:Acute Disease; D000368:Aged; D002908:Chronic Disease; D003161:Compartment Syndromes / Q000209:etiology / Q000503:physiopathology; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010192:Pancreatic Pseudocyst / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D010195:Pancreatitis / Q000150:complications; D011312:Pressure; D011446:Prospective Studies; D016896:Treatment Outcome