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Open AccessArticle

Interventional and surgical management of abdominal compartment syndrome in severe acute pancreatitis

1
Institute for Biomedical Research, Kaunas University of Medicine
2
Department of Surgery, Kaunas University of Medicine, Lithuania
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Author to whom correspondence should be addressed.
Medicina 2010, 46(4), 249; https://doi.org/10.3390/medicina46040034
Received: 2 February 2009 / Accepted: 6 April 2010 / Published: 11 April 2010
Background and objective. Management of the abdominal compartment syndrome during severe acute pancreatitis by the open abdomen method is associated with considerable morbidity and resource utilization. Thus, the aim of this study was to evaluate the safety and efficacy of the ultrasound-guided percutaneous interventions and/or minimally invasive surgery in the treatment of abdominal compartment syndrome.
Material and methods.
Forty-four patients with severe acute pancreatitis were enrolled into a prospective study and treated according to the standard management protocol. Interventional and/ or surgical management of abdominal compartment syndrome was employed in 6 (13.6%) cases. In the context of this study, we assessed the feasibility and effectiveness of subcutaneous fasciotomy of the anterior m. rectus abdominis sheath, as well as the role of ultrasound-guided drainage of intra-abdominal and peripancreatic fluid collections in the management of abdominal compartment syndrome.
Results
. Subcutaneous fasciotomy of the anterior m. rectus sheath and ultrasound-guided drainage of intra-abdominal and peripancreatic fluid collections seem to be safe (minor risk of bleeding or infection, closed abdomen, and easy care for the patient) and effective (resulted in a sustained decrease of intra-abdominal pressure to 13–16 mm Hg and regression of organ failures after intervention). Subcutaneous anterior m. rectus fasciotomy may appear to be beneficial in case of refractory abdominal compartment syndrome avoiding morbidity associated with the open abdomen technique.
Conclusions
. Both the subcutaneous fasciotomy and ultrasound-guided drainage of intra-abdominal and/or peripancreatic fluid collections seem to be safe and effective alternatives in the management of abdominal compartment syndrome; however, prospective studies are needed to further evaluate their clinical role.
Keywords: acute pancreatitis; abdominal compartment syndrome; organ dysfunction; surgery acute pancreatitis; abdominal compartment syndrome; organ dysfunction; surgery
MDPI and ACS Style

Dambrauskas, Ž.; Paršeliūnas, A.; Maleckas, A.; Gulbinas, A.; Barauskas, G.; Pundzius, J. Interventional and surgical management of abdominal compartment syndrome in severe acute pancreatitis. Medicina 2010, 46, 249.

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