Bedside Laparotomy and Decompression of Abdominal Compartment Syndrome

  • Erin Palm
  • Daniel GraboEmail author


  • Intra-abdominal hypertension (IAH) is defined as a sustained intra-abdominal pressure, as measured with bladder pressure, >12 mmHg in adults or >10 mmHg in children. Abdominal compartment syndrome (ACS) is defined as a sustained bladder pressure >20 mmHg in adults or >10 mmHg in children, combined with evidence of new organ dysfunction or failure, i.e., respiratory or renal failure.

  • ACS may be primary (due intra-abdominal conditions such as trauma, major surgery, peritonitis) or secondary (due to extra-abdominal conditions, such as massive fluid administration in burns or trauma).

  • IAH and ACS should be suspected in the presence of a distended abdomen and are often associated with increasing peak inspiratory pressure in mechanically ventilated patients, progressive hypoxia and hypercapnia, tachycardia, hypotension, and oliguria.

  • The diagnosis of ACS is confirmed by elevated intra-abdominal pressure (reference pressures above) as measured by bladder pressures in combination with any of the above clinical findings.

  • In patients with borderline ACS, the intra-abdominal pressure can be reduced by restricting intravenous fluids, pain control, pharmacological paralysis, decompression of the gastrointestinal tract by means of a gastric or rectal tubes, and percutaneous drainage of large ascites (often effective in burn patients).

  • In patients with severe ACS not responding to conventional measures, a decompressive laparotomy should be considered without any delay.

  • Decompressive laparotomy is usually performed in the operating room. However, in some cases with severe ACS, bedside laparotomy in the ICU should be performed. Indications for bedside laparotomy include:
    • Patient instability for transport.

    • Operating room unavailable.

    • Suboptimal, austere environments, where a fully equipped OR may not be available in a timely manner.

  • During decompressive laparotomy, the patient may experience severe hemodynamic decompensation or cardiac arrest, due to pooling of significant blood volume in the visceral vascular bed and reperfusion effects.

  • Following decompressive laparotomy, the abdomen should be managed with temporary abdominal wall closure.

  • Surgical definitive abdominal wall closure should be performed at the earliest possible time to avoid complications associated with having an open abdomen, such as entero-atmospheric fistulas and fascial retraction.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Southern California, Los Angeles County Medical CenterLos AngelesUSA
  2. 2.West Virginia UniversityMorgantownUSA

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