The Abdominal Compartment Syndrome

  • James M. Doty
  • Jun Oda
  • Rao R. Ivatury
  • Harvey J. Sugerman


Abdominal compartment syndrome (ACS) occurs when elevated intraabdominal pressure (IAP) causes dysfunction in one or more organ systems. ACS is most commonly seen in trauma patients and in postoperative patients; however, it may occur in numerous other settings as well (See Table 1). Elevation of IAP may occur acutely, causing acute ACS (AACS), or chronically, causing chronic ACS. IAP may also be elevated subacutely as is proposed in preeclampsia. Regardless of the etiology or duration of onset, ACS affects a significant number of critically ill patients and is associated with substantial morbidity and mortality if not treated appropriately.


Inferior Vena Caval Cerebral Perfusion Pressure Superior Vena Caval Abdominal Compartment Syndrome Intraabdominal Pressure 
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  1. 1.
    Schein M, Ivatury R. Intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 1998; 85: 1027–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Kron IL, Hannan PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg 1984; 199: 28–30.PubMedCrossRefGoogle Scholar
  3. 3.
    Meldrum DR, Moore FA, Moore EE, Franciose RJ, Sauaia A, Burch JM. Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg 1997; 174: 667–73.PubMedCrossRefGoogle Scholar
  4. 4.
    Saggi BH, Sugerman HJ, Ivatury RR, Bloomfield GL. Abdominal compartment syndrome. J Trauma 1998; 45: 597–609.PubMedCrossRefGoogle Scholar
  5. 5.
    Ivatury RR, Porter JM, Simon RI, Islam S, John R, Stahl WM. Intra-abdominal hypertension after life-threatening penetrating abdominal trauma: prophylaxis, incidence and clinical relevance to gastric mucosal pH and abdominal compartment syndrome. J Trauma 1998; 44: 1016–23.PubMedCrossRefGoogle Scholar
  6. 6.
    Sugrue M, Buist MD, Lee A, Sanchez DJ, Hillman KM. Intra-abdominal pressure measurement using a modified nasogastric tube: description and validation of a new technique. Intensive Care Med 1994; 20: 588–90.PubMedCrossRefGoogle Scholar
  7. 7.
    Iberti TJ, Kelly KM, Gentili DR, Hirsch S, Benjamin E. A simple technique to accurately determine infra-abdominal pressure. Crit Care Med 1987; 15: 1140–2.PubMedCrossRefGoogle Scholar
  8. 8.
    Ridings PC, Bloomfield GL, Blocher CR, Sugerman HJ. Cardiopulmonary effects of raised infra- abdominal pressure before and after intravascular volume expansion. J Trauma 1995; 39: 1071–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Richardson JD, Trinkle JK. Hemodynamic and respiratory alterations with increased intra- abdominal pressure. J Surg Res 1976; 20: 401–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Cullen DJ, Coyle JP, Teplick R, Long MC. Cardiovascular, pulmonary, and renal effects of massively increased infra-abdominal pressure in critically ill patients. Crit Care Med 1989; 17: 118–21.PubMedCrossRefGoogle Scholar
  11. 11.
    Kashtan J, Green JF, Parsons EQ, Holcroft JW. Hemodynamic effects of increased abdominal pressure. J Surg Res 1981; 30: 249–55.PubMedCrossRefGoogle Scholar
  12. 12.
    Chang MC, Miller PR, D’Agostino R Jr, Meredith JW. Effects of abdominal decompression on cardiopulmonary function and visceral perfusion in patients with intra-abdominal hypertension. J Trauma 1998; 44: 440–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Kirsch AJ, Hensle TW, Chang DT, Kayton ML, Olsson CA, Sawczuk IS. Renal effect of CO2 insufflation: oliguria and acute renal dysfunction in a rat pneumoperitoneum model. Urology 1994; 43: 453–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Richards WO, Scovill W, Shin B, Reed W. Acute renal failure associated with increased intra- abdominal pressure. Ann Surg 1983; 197: 183–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Doty JM, Saggi BH, Sugerman HJ, Blocher CR, Pin R, Fakhry 1, Gehr TW, Sica DA. Effect of increased renal venous pressure on renal function. J Trauma 1999; 47: 1000–3.PubMedCrossRefGoogle Scholar
  16. 16.
    Harman PK, Kron IL, McLachlan HD, Freedlender AE, Nolan SP. Elevated infra-abdominal pressure and renal function. Ann Surg 1982; 196: 594–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Doty JM, Saggi BH,Blocher CR, Sugerman HJ, Fakhry 1, Gehr T, Sica D., Effects of increased renal parenchymal pressure on renal function. J Trauma 2000; 48: 874–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Mutoh T, Lamm WJ, Embree LJ, Hildebrandt J, Albert RK. Volume infusion produces abdominal distension, lung compression, and chest wall stiffening in pigs. J Appl Physiol 1992; 72: 575–82.PubMedCrossRefGoogle Scholar
  19. 19.
    Obeid F, Saba A, Fath J, Guslits B, Chung R, Sorensen V, Buck J, Horst M. Increases in intra- abdominal pressure affect pulmonary compliance. Arch Surg 1995; 130: 544–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Eddy V, Nunn C, Morris JA Jr. Abdominal compartment syndrome. The Nashville experience. Surg Clin North Am 1997; 77: 801–12.PubMedCrossRefGoogle Scholar
  21. 21.
    Diebel LN, Wilson RF, Dulchaysky SA, Saxe J. Effect of increased infra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J Trauma 1992; 33: 279–83.PubMedCrossRefGoogle Scholar
  22. 22.
    Ivatury RR, Diebel L, Porter JM, Simon RJ. Intra-abdominal hypertension and the abdominal compartment syndrome. Surg Clin North Am 1997; 77: 783–800.PubMedCrossRefGoogle Scholar
  23. 23.
    Pickhardt PJ, Shimony JS, Heiken JP, Buchman TG, Fisher AJ. The abdominal compartment syndrome: CT findings. AJR Am J Roentgenol 1999; 173: 575–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Saggi BH, Bloomfield GL, Sugerman HJ, Blocher CR, Hull JP, Marmarou AP, Bullock MR. Treatment of intracranial hypertension using nonsurgical abdominal decompression. J Trauma 1999; 46: 646–51.PubMedCrossRefGoogle Scholar
  25. 25.
    Bloomfield GL, Dalton IM, Sugerman HJ, Ridings PC, DeMaria EJ, Bullock R. Treatment of increasing intracranial pressure secondary to the acute abdominal compartment syndrome in a patient with combined abdominal and head trauma. J Trauma 1995; 39: 1168–70.PubMedCrossRefGoogle Scholar
  26. 26.
    Bloomfield GL, Ridings PC, Blocher CR, Marmarou A, Sugerman HJ. A proposed relationship between increased intra-abdominal, intrathoracic, and intracranial pressure. Crit Care Med 1997; 25: 496–503.PubMedCrossRefGoogle Scholar
  27. 27.
    Diebel L, Saxe J, Dulchaysky S. Effect of intra-abdominal pressure on abdominal wall blood flow. Am Surg 1992; 58: 573–6.PubMedGoogle Scholar
  28. 28.
    Morris JA Jr, Eddy VA, Blinman TA, Rutherford EJ, Sharp KW. The staged celiotomy for trauma. Issues in unpacking and reconstruction. Ann Surg 1993; 217: 576–86.PubMedCrossRefGoogle Scholar
  29. 29.
    Moore EE. Thomas G. Orr Memorial Lecture. Staged laparotomy for the hypothermia, acidosis and coagulopathy syndrome. Am J Surg 1996; 172: 405–10.PubMedCrossRefGoogle Scholar
  30. 30.
    Schein M, Wittmann DH, Aprahamian CC, Condon RE. The abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure. J Am Coll Surg 1995; 180: 745–53.PubMedGoogle Scholar
  31. 31.
    Burch JM, Ortiz VB, Richardson RJ, Martin RR, Mattox KL, Jordan GL. Abbreviated laparotomy and planned reoperation for critically injured patients. Ann Surg 1992; 215: 476–84.PubMedCrossRefGoogle Scholar
  32. 32.
    Mayberry JC, Goldman RK, Mullins RJ, Brand DM, Crass RA, Trunkey key DD. Surveyed opinion of American trauma surgeons on the prevention of the abdominal compartment syndrome. J Trauma 1999; 47: 509–14.Google Scholar
  33. 33.
    Rizzo A, Davis PC, Hamm CR, Powell RW. Intraoperative vesical pressure measurements as a guide in the closure of abdominal wall defects. Am Surg 1996; 62: 192–6.PubMedGoogle Scholar
  34. 34.
    Lacey SR, Bruce J, Brooks SP, Griswald J, Ferguson W, Allen JE, Jewett TC Jr, Karp MP, Cooney DR. The relative merits of various methods of indirect measurement of intra-abdominal pressure as a guide to closure of abdominal wall defects. J Pediatr Surg 1987; 22: 1207–11.PubMedCrossRefGoogle Scholar
  35. 35.
    Mayberry JC, Mullins RJ, Crass RA, Trunkey DD. Prevention of abdominal compartment syndrome by absorbable mesh prosthesis closure. Arch Surg 1997; 132: 957–62.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • James M. Doty
    • 1
  • Jun Oda
    • 1
  • Rao R. Ivatury
    • 1
  • Harvey J. Sugerman
    • 1
  1. 1.Medical College of VirginiaRichmondUSA

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