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Traumatic Abdominal Compartment Syndrome

  • Luigia Romano
  • Carlo Liguori
  • Ciro Acampora
  • Nicola Gagliardi
  • Antonio Pinto
  • Sonia Fulciniti
  • Massimo Silva
Chapter

Abstract

Traumatic abdominal compartment syndrome (ACS) can result from a blunt or penetrating trauma which involves abdominal and pelvic cavity. A direct injury to the abdomen or pelvis can cause vascular, tissue, and organ injuries which are frequently associated with ongoing hemorrhage. The severe bleeding causes hypoperfusion to organs and tissues, whereas the collection of blood within the abdominal and pelvic cavity can cause intra-abdominal hypertension (IAH). Both conditions can result in tissue and organ hypoxia. Traumatic ACS is diagnosed when the intra-abdominal pressure is greater than 20 mmHg, with the development of single- or multiple-organ dysfunction. In the acute setting of a severely injured patient, it is mandatory to control bleeding and restore coagulation function. Many patients need massive fluid resuscitation and are treated with abdominal packing. In presence of life-threatening hemorrhage, these treatments are necessary, but these same factors also increase the risk of developing ACS. Traumatic ACS is a clinical syndrome which may easily be misinterpreted, and can lead to worsening of patient outcome. It is essential to diagnose and manage ACS early, because without a rapid intervention the risk of death is high. It is considered a complication that is potentially reversible. Abdominal decompression of ACS rapidly improves cardiac, pulmonary, and renal functioning. With the use of multi-detector computed tomography (MDCT) for the assessment and follow-up of severe blunt and penetrating injuries, an unsuspected ACS can be diagnosed early, before the development of severe organ or multi-organ dysfunction. CT can provide evidence of some indicative features of increased intra-abdominal pressure in patients at risk for developing ACS, including large hematomas. The partnership between the radiologist and surgeon to utilize both clinical and CT findings to detect early ACS provides a more precise method for the detection and rapid treatment of this lethal but potentially reversible syndrome. Radiologists could be increasingly likely to evaluate patients with ACS in the presence of abdominal and/or pelvic hemorrhage and/or postsurgical application of packs. Correct early radiological diagnosis of ACS is based on the knowledge of the MDCT findings, as well as awareness of the pathophysiology of the syndrome.

Keywords

Traumatic abdominal compartment syndrome Intra-abdominal hypertension Blunt or penetrating abdominal and pelvic trauma Traumatic space-occupying processes Organ and tissue hypoperfusion Single- or multiple-organ dysfunction Bladder pressure measurement Damage-control surgery 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Luigia Romano
    • 1
  • Carlo Liguori
    • 1
  • Ciro Acampora
    • 1
  • Nicola Gagliardi
    • 1
  • Antonio Pinto
    • 1
  • Sonia Fulciniti
    • 1
  • Massimo Silva
    • 1
  1. 1.Department of General and Emergency RadiologyA.O.R.N A. CardarelliNaplesItaly

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