Interventional and surgical management of abdominal compartment syndrome in severe acute pancreatitis.
OBJECTIVE
Management of the abdominal compartment syndrome during severe acute pancreatitis by the open abdomen method is associated with considerable morbidity and resource utilization. Thus, the aim of this study was to evaluate the safety and efficacy of the ultrasound-guided percutaneous interventions and/or minimally invasive surgery in the treatment of abdominal compartment syndrome.


METHODS
Forty-four patients with severe acute pancreatitis were enrolled into a prospective study and treated according to the standard management protocol. Interventional and/or surgical management of abdominal compartment syndrome was employed in 6 (13.6%) cases. In the context of this study, we assessed the feasibility and effectiveness of subcutaneous fasciotomy of the anterior m. rectus abdominis sheath, as well as the role of ultrasound-guided drainage of intra-abdominal and peripancreatic fluid collections in the management of abdominal compartment syndrome.


RESULTS
Subcutaneous fasciotomy of the anterior m. rectus sheath and ultrasound-guided drainage of intra-abdominal and peripancreatic fluid collections seem to be safe (minor risk of bleeding or infection, closed abdomen, and easy care for the patient) and effective (resulted in a sustained decrease of intra-abdominal pressure to 13-16 mm Hg and regression of organ failures after intervention). Subcutaneous anterior m. rectus fasciotomy may appear to be beneficial in case of refractory abdominal compartment syndrome avoiding morbidity associated with the open abdomen technique.


CONCLUSIONS
Both the subcutaneous fasciotomy and ultrasound-guided drainage of intra-abdominal and/or peripancreatic fluid collections seem to be safe and effective alternatives in the management of abdominal compartment syndrome; however, prospective studies are needed to further evaluate their clinical role.
Dambrauskas
Zilvinas
Z
Institute for Biomedical Research, Kau-nas University of Medicine, 50009 Kaunas, Lithuania. zilvinas.dambrauskas@gmail.com
Parseliūnas
Audrius
A
Maleckas
Almantas
A
Gulbinas
Antanas
A
Barauskas
Giedrius
G
Pundzius
Juozas
J
D000005:Abdomen / Q000601:surgery; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects; D003161:Compartment Syndromes / Q000150:complications / Q000175:diagnosis / Q000601:surgery / Q000628:therapy; D003627:Data Interpretation, Statistical; D019299:Decompression, Surgical; D004322:Drainage / Q000379:methods; D000071938:Fasciotomy; D005240:Feasibility Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D008150:Lower Body Negative Pressure; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009102:Multiple Organ Failure / Q000209:etiology*; D010195:Pancreatitis / Q000150:complications* / Q000601:surgery; D017410:Practice Guidelines as Topic; D013997:Time Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid