Abstract
Beyond the classical ICU, surgical and trauma patients, intra-abdominal hypertension (IAH >12 mmHg) contributes substantially to organ disfunction also in critically ill obese patients and pregnant women. Chronic elevation in intra-abdominal pressure (IAP) is common in obese patients and may be responsible for the pathogenesis of obesity-related comorbidities, such as reduced venous return, pulmonary disfunction, gastroesophageal reflux disease and abdominal wall hernias.
Abdominal compartment syndrome (ACS) occurs at an IAH >20 mmHg, and this may cause severe new organ dysfunction and death, the renal function being compromised first. Obese patients at risk of IAH/ACS should be identified by measuring IAP with a simple bladder catheter connected to a pressure transducer. In cases of IAH/ACS the international guidelines suggest a preliminary medical treatment followed by a surgical decompression if it failed. At the end of the surgical procedure, the option to leave an open abdomen should be carefully considered and a temporary abdominal closure with an active system must be considered.
In conclusion, the treatment of ACS in obese patients is more challenging and may be associated with higher complication rates, but substantially it does not differ from the management of ACS in non-obese patients.
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Viganò, J., D’Ovidio, A., Bocca, G., Dionigi, P. (2020). Abdominal Compartment Syndrome in Obese Patients. In: Foschi, D., Navarra, G. (eds) Emergency Surgery in Obese Patients. Updates in Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-17305-0_12
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DOI: https://doi.org/10.1007/978-3-030-17305-0_12
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