• Abdominal compartment syndrome
• Acute pancreatitis
• Decompression laparotomy
• Intra-abdominal hypertension
• Intra-abdominal pressure
• Midline laparotomy

• Gastrointestinal dysmotility
• Neostigmine
• Randomized controlled trial
• Severe acute pancreatitis

• abdominal compartment syndrome
• acute pancreatitis
• compartment syndrome
• intra-abdominal hypertension
• surgery

Patients with severe acute pancreatitis (SAP) present complications and organ failure, which require treatment in critical care units. These extrapancreatic complications determine the clinical outcome of the disease. Intra-abdominal hypertension (IAH) deteriorates the prognosis of SAP. In this paper, relevant recent literature was reviewed, as well as the authors’ own experiences, concerning the clinical importance of IAH and its treatment in SAP. The principal observations confirmed that IAH is a frequent consequence of SAP but is practically absent in mild disease. Common manifestations of AP such as pain, abdominal distension, and paralytic ileus contribute to increased abdominal pressure, as well as fluid loss in third space and aggressive fluid replacement therapy. A severe increase in IAP can evolve to abdominal compartment syndrome and new onset organ failure. Conservative measures are useful, but invasive interventions are necessary in several cases. Percutaneous drainage of major collections is preferred when possible, but open decompressive laparotomy is the final possibility in some cases in order to definitively reduce abdominal pressure. Intra-abdominal pressure should be measured in all SAP cases that worsen despite adequate treatment in critical care units. Conservative measures must be introduced to treat IAH, including negative fluid balance, digestive decompression by gastric–rectal tube, and prokinetics, including neostigmine. In the case of insufficient responses to these measures, minimally invasive interventions should be preferred.

• abdominal compartment syndrome
• abdominal pressure
• intraabdominal hypertension

Acute pancreatitis is a risk factor for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Immediate detection and management of IAH and ACS are critical for patient survival. Obtaining accurate and consistent intra-abdominal pressure and urinary output with high frequency is challenging, but critical for effective patient management. The presented case is of a 40-year-old man with a history of chronic alcoholism who developed severe acute pancreatitis. The patient was fluid resuscitated for distributive shock; hypoxic respiratory failure, intubation, and anuria followed. Real-time monitoring of urinary output and intra-abdominal pressure (IAP) allowed for early recognition of acute kidney injury (AKI) and ACS leading to early surgical intervention. Normalized IAP returned renal function and re-establishment of stable hemodynamics without vasopressors.

• continuous veno-venous hemofiltration
• intra-abdominal pressure
• severe acute pancreatitis

• Acute Disease
• Adult
• Aged
• Cohort Studies
• Continuous Renal Replacement Therapy
• Hemofiltration
• Humans
• Intra-Abdominal Hypertension/diagnosis
• Intra-Abdominal Hypertension/etiology
• Male
• Middle Aged
• Pancreatitis/complications
• Pancreatitis/therapy
• Pressure
• Prospective Studies
• Treatment Outcome

• Abbreviated laparotomy
• Emergency
• Intra-abdominal hypertension
• Intravesical pressure
• Laparostomy
• Open abdomen

Abdominal compartment syndrome (ACS) is an uncommon complication of severe pancreatitis. It is defined as a sustained intraabdominal pressure (IAP) > 20 mmHg (with or without an abdominal perfusion pressure (APP) < 60 mmHg), associated with new organ dysfunction/failure. ACS confers a poor prognosis and should be promptly diagnosed and managed. However, it is often missed on clinical examination, leading to a delay of diagnosis.

A 38-year old Sri Lankan man presented with severe alcohol-induced pancreatitis associated with abdominal compartment syndrome. Diagnosis was delayed due to false reassurance from clinical examination. The patient was managed with a decompressive laparotomy, after which he required treatment with continuous renal replacement therapy (CRRT), total parenteral nutrition (TPN) and broad-spectrum antibiotics for a prolonged period of time. Despite significant post-operative multi-organ failure, the patient survived.

Early trans-bladder measurement of IAP is important for severe pancreatitis. Serial measurements of IAP should be implemented early when any known risk factor for ACS is present in a critically ill patient.

• Case reports
• Decompression, surgical
• Intra-abdominal hypertension
• Laparotomy
• Multiple organ failure
• Pancreatitis

• Abdominal compartment syndrome
• Acute pancreatitis
• Decompressive laparotomy
• Severe acute pancreatitis
• Surgical abdominal decompression

• Decompression, Surgical/methods
• Humans
• Intra-Abdominal Hypertension/diagnostic imaging
• Intra-Abdominal Hypertension/etiology
• Intra-Abdominal Hypertension/surgery
• Laparotomy/methods
• Pancreatitis/diagnostic imaging
• Pancreatitis/surgery

• Biliary acute pancreatitis
• Cholecystectomy
• Common bile duct stones
• Endoscopic retrograde cholangiopancreatography

• Pancreatitis
• abdominal compartment syndrome
• hypertriglyceridemia
• pregnancy

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.

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.

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.

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.

• Aged
• Decompression, Surgical
• Female
• Humans
• Intestines/blood supply
• Intra-Abdominal Hypertension/etiology
• Intra-Abdominal Hypertension/surgery
• Ischemia/etiology
• Laparotomy
• Male
• Middle Aged
• Pancreatitis/complications
• Retrospective Studies

Patients with an open abdomen (OA) treated with temporary abdominal closure (TAC) need multiple surgical procedures throughout the hospital stay with repeated changes of the vacuum-assisted closure device (VAC changes). The aim of this study was to examine if using the intensive care unit (ICU) for dressing changes in OA patients was safe regarding bloodstream infections (BSI) and survival. Secondary aims were to evaluate saved time, personnel, and costs.

All patients treated with OA in the ICU from October 2006 to June 2014 were included. Data were retrospectively obtained from registered procedure codes, clinical and administrative patients’ records and the OR, ICU, anesthesia and microbiology databases. Outcomes were 30-, 60- and 90-day survival, BSI, time used and saved personnel costs.

A total of 113 patients underwent 960 surgical procedures including 443 VAC changes as a single procedure, of which 165 (37 %) were performed in the ICU. Nine patients died before the first scheduled dressing change and six patients were closed at the first scheduled surgery after established OA, leaving 98 patients for further analysis. The mean duration for the surgical team performing a VAC change in the ICU was 63.4 (60.4–66.4) minutes and in the OR 98.2 (94.6–101.8) minutes (p < 0.001). The mean duration for the anesthesia team in the OR was 115.5 minutes, while this team was not used in the ICU. Personnel costs were reduced by €682 per procedure when using the ICU. Forty-two patients had all the VAC changes done in the OR (VAC-OR), 22 in the ICU (VAC-ICU) and 34 in both OR and ICU (VAC-OR/ICU). BSI was diagnosed in eight (19 %) of the VAC-OR patients, seven (32 %) of the VAC-ICU and eight (24 %) of the VAC-OR/ICU (p = 0.509). Thirty-five patients (83 %) survived 30 days in the VAC-OR group, 17 in the VAC-ICU group (77 %) and 28 (82 %) in the VAC-OR/ICU group (p = 0.844).

VAC change for OA in the ICU saved time for the OR team and the anesthesia team compared to using the OR, and it reduced personnel costs. Importantly, the use of ICU for OA dressing change seemed to be as safe as using the OR.

• Abdominal compartment syndrome
• Dressing changes
• Health economy
• Infections
• Intensive care
• Open abdomen
• Resources

Abdominal compartment syndrome (ACS) in patients with severe acute pancreatitis (SAP) is a marker of severe disease. It occurs as combination of inflammation of retroperitoneum, visceral edema, ascites, acute peripancreatic fluid collections, paralytic ileus, and aggressive fluid resuscitation. The frequency of ACS in SAP may be rising due to more aggressive fluid resuscitation, a trend towards conservative treatment, and attempts to use a minimally invasive approach. There remains uncertainty about the most appropriate surgical technique for the treatment of ACS in SAP. Some unresolved questions remain including medical treatment, indications, timing, and interventional techniques. This review will focus on interventional treatment of this serious condition. First line therapy is conservative treatment aiming to decrease IAP and to restore organ dysfunction. If nonoperative measures are not effective, early abdominal decompression is mandatory. Midline laparostomy seems to be method of choice. Since it carries significant morbidity we need randomized studies to establish firm advantages over other described techniques. After ACS resolves efforts should be made to achieve early primary fascia closure. Additional data are necessary to resolve uncertainties regarding ideal timing and indication for operative treatment.

• Complications
• Conservative treatment
• Interventional therapy
• Severe acute pancreatitis
• Therapeutics

• Acute pancreatitis
• Antibiotics
• Bundles
• Diagnosis
• Guidelines
• Intensive care
• Nutrition
• Pancreas
• Post-ERCP pancreatitis
• Severity assessment
• Surgery

• Abdominal compartment syndrome
• Acute pancreatitis
• Decompressive laparotomy
• Intra-abdominal hypertension
• Intra-abdominal pressure
• Severe acute pancreatitis

• Appendicitis
• Cholangitis
• Cholecystitis
• Clostridium difficile
• Colitis
• Diverticulitis
• Pancreatitis