Advertisement

Acute Compartment Syndrome

  • Fabio Ferla
  • Arianna Ciravegna
  • Anna Mariani
  • Vincenzo Buscemi
  • Riccardo De Carlis
  • Paolo Aseni
Chapter

Abstract

Compartment syndrome is defined as an elevation of the interstitial pressure in a closed osseo-fascial compartment that results in microvascular compromise. It could happen in any compartment of the body, and recognizing it can be lifesaving.

The main risk factors for abdominal compartment syndrome are diminished abdominal wall compliance, increased intra-abdominal contents, increased intraluminal contents, and capillary leak/fluid resuscitation. The diagnosis of abdominal compartment syndrome could be confirmed with bladder pressure measurement. Abdominal compartment syndrome could benefit from conservative treatment (decreasing intraluminal gastrointestinal contents, evacuation of intra-abdominal space-occupying lesions, improving abdominal wall compliance, optimizing fluid management and perfusion) or surgical treatment (laparostomy, subcutaneous linea alba fasciotomy, extraperitoneal posterior decompression).

The main risk factors for acute compartment syndrome of the extremities are trauma and limb fractures, old age, vascular injuries, and ischemia/reperfusion episodes. The diagnosis is made by clinical exam in most of the cases. Treatment is surgical decompression and should be undertaken in less than 8 h from the onset of the syndrome start.

References

  1. 1.
    von Volkmann R. The classic: ischaemic muscle paralyses and contractures. Clin Orthop Relat Res. 2007;456:20–1.  https://doi.org/10.1097/BLO.0b013e318032561f.CrossRefGoogle Scholar
  2. 2.
    Jepson PN. Ischaemic contracture: experimental study. Ann Surg. 1926;84:785–95.CrossRefGoogle Scholar
  3. 3.
    Rorabeck CH. The treatment of compartment syndromes of the leg. J Bone Joint Surg Br. 1984;66:93–7.CrossRefGoogle Scholar
  4. 4.
    Kirkpatrick AW, Roberts DJ, De Waele J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013;39:1190–206.  https://doi.org/10.1007/s00134-013-2906-z.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Sugrue M, Bauman A, Jones F, et al. Clinical examination is an inaccurate predictor of intraabdominal pressure. World J Surg. 2002;26:1428–31.  https://doi.org/10.1007/s00268-002-6411-8.CrossRefPubMedGoogle Scholar
  6. 6.
    Kirkpatrick AW, Brenneman FD, McLean RF, et al. Is clinical examination an accurate indicator of raised intra-abdominal pressure in critically injured patients? Can J Surg. 2000;43:207–11.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Cheatham ML. Nonoperative management of intraabdominal hypertension and abdominal compartment syndrome. World J Surg. 2009;33:1116–22.  https://doi.org/10.1007/s00268-009-0003-9.CrossRefPubMedGoogle Scholar
  8. 8.
    Leppäniemi A. Surgical management of abdominal compartment syndrome; indications and techniques. Scand J Trauma Resusc Emerg Med. 2009;17:17.  https://doi.org/10.1186/1757-7241-17-17.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk? J Bone Joint Surg Br. 2000;82:200–3.CrossRefGoogle Scholar
  10. 10.
    Branco BC, Inaba K, Barmparas G, et al. Incidence and predictors for the need for fasciotomy after extremity trauma: a 10-year review in a mature level I trauma centre. Injury. 2011;42:1157–63.  https://doi.org/10.1016/j.injury.2010.07.243.CrossRefPubMedGoogle Scholar
  11. 11.
    Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome: a review. Cardiovasc Surg. 2002;10:620–30.CrossRefGoogle Scholar
  12. 12.
    Hargens AR, Romine JS, Sipe JC, et al. Peripheral nerve-conduction block by high muscle-compartment pressure. J Bone Joint Surg Am. 1979;61:192–200.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Fabio Ferla
    • 1
  • Arianna Ciravegna
    • 1
    • 2
  • Anna Mariani
    • 1
  • Vincenzo Buscemi
    • 1
    • 3
  • Riccardo De Carlis
    • 1
    • 3
  • Paolo Aseni
    • 4
  1. 1.Department of General Surgery and TransplantationASST Grande Ospedale Metropolitano, Niguarda Ca’ Granda HospitalMilanItaly
  2. 2.Department of SurgeryUniversity of Milano-Bicocca, San Gerardo HospitalMonzaItaly
  3. 3.Department of Surgical SciencesUniversity of PaviaPaviaItaly
  4. 4.Dipartimento di Emergenza UrgenzaASST Grande Ospedale Metropolitano NiguardaMilanItaly

Personalised recommendations