← Diagnosis and Management Guides
Abdominal Compartment Syndrome
Key considerations: Intra-abdominal hypertension progressing to ACS, Missed in ICU post-damage control surgery, Multiorgan failure from untreated ACS
Cannot miss
- Intra-abdominal hypertension progressing to ACS
- Missed in ICU post-damage control surgery
- Multiorgan failure from untreated ACS
Likely diagnoses
- Post-surgical ACS
- Massive fluid resuscitation ACS
- Pancreatitis with third-spacing
- Intra-abdominal hemorrhage
Red flags
- Bladder pressure >20 mmHg with new organ dysfunction
- Tense/rigid abdomen
- Oliguria despite adequate resuscitation
- Elevated peak airway pressures
- Massive resuscitation (>10L in 24 hours)
Workup
- history: Recent surgery, massive resuscitation, trauma, pancreatitis, burns; exam: Tense distended abdomen, hemodynamic instability, poor urine output, elevated ventilator pressures; labs: ABG (metabolic acidosis), BMP, lactate, urine output monitoring; imaging: Bladder pressure measurement (gold standard — normal <12 mmHg, ACS >20 mmHg with organ dysfunction); Abdominal CT (bowel wall thickening, rounded abdomen sign); bedside: Serial bladder pressure measurements, urine output, ventilator pressures
Management
- immediate: Grade III-IV (>20 mmHg with organ dysfunction): emergent decompressive laparotomy; general: Grade I-II (12-20 mmHg): optimize positioning (HOB flat), nasogastric decompression, neuromuscular blockade, diuresis; Open abdomen management with temporary closure device post-decompression; Serial bladder pressure monitoring
Disposition
- admit: ICU — surgical emergency if decompressive laparotomy indicated; discharge: Never acutely; consults: Surgery emergently, critical care
Clinical pearls
- Bladder pressure measurement: fill bladder with 25 mL saline, measure at end-expiration with patient supine
- Always measure in post-damage control surgery patients and after massive resuscitation
- ACS causes renal failure (compressed renal veins), respiratory failure (elevated diaphragm), and cardiac failure (decreased venous return)
Source and review
- WSACS Abdominal Compartment Syndrome Consensus 2023. Last reviewed: 2024-11-01