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2016 ; 40
(6
): 1454-61
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Abdominal Compartment Syndrome and Intra-abdominal Ischemia in Patients with
Severe Acute Pancreatitis
#MMPMID26830909
Smit M
; Buddingh KT
; Bosma B
; Nieuwenhuijs VB
; Hofker HS
; Zijlstra JG
World J Surg
2016[Jun]; 40
(6
): 1454-61
PMID26830909
show ga
INTRODUCTION: Severe acute pancreatitis may be complicated by intra-abdominal
hypertension (IAH), abdominal compartment syndrome (ACS), and intestinal
ischemia. The aim of this retrospective study is to describe the incidence,
treatment, and outcome of patients with severe acute pancreatitis and ACS, in
particular the occurrence of intestinal ischemia. METHODS: The medical records of
all patients admitted with severe acute pancreatitis admitted to the ICU of a
tertiary referral center were reviewed. The criteria proposed by the World
Society of the Abdominal Compartment Syndrome (WSACS) were used to determine
whether patients had IAH or ACS. RESULTS: Fifty-nine patients with severe acute
pancreatitis were identified. Intra-abdominal pressure (IAP) measurements were
performed in 29 patients (49.2 %). IAH was present in all patients (29/29). ACS
developed in 13/29 (44.8 %) patients. Ten patients with ACS underwent
decompressive laparotomy. A large proportion of patients with ACS had
intra-abdominal ischemia upon laparotomy: 8/13 (61.5 %). Mortality was high in
both the ACS group and the IAH group. CONCLUSION: This study confirms that ACS is
common in severe acute pancreatitis. Intra-abdominal ischemia occurs in a large
proportion of patients with ACS. Swift surgical intervention may be indicated
when conservative measures fail in patients with ACS. National and international
guidelines need to be updated so that routine IAP measurements become standard of
care for patients with severe acute pancreatitis in the ICU.