[Abdominal compartment syndrome following damage-control surgery: pathophysiology and decompression of intraabdominal...

In Stone's milestone article on damage-control surgery (DCS) (Ann Surg 1983; 197:532-535), detailed clinical observations of abdominal compartment syndrome (ACS) were presented although the concept of ACS had not yet been established at that time. Since then the concept of ACS has been developed concomitantly with the widespread application of DCS for severe trauma victims. Intraabdominal pressure (IAP) is the most important factor for determining the severity of pathophysiological consequences in patients with ACS. Increased IAP pushes the diaphragm upward, which may cause deterioration of pulmonary function. Increased IAP decreases the glomerular filtration rate and urinary secretion. Patients with severe torso injury may have intraabdominal and/or retroperitoneal hematomaor edema formation in the mesentery, and all those can be factors that elevate IAP. About one-third of patients who undergo DCS develop ACS. Decompression of IAP clearly ameliorates physiological parameters in those patients, although the, mortality rate may not be improve despite adequate control of IAP. This suggest that in addition to elevated IAP other factors such as increased cytokine production might be important in ACS. Inserting a plastic infusion bag between intraabdominal organs and the abdominal wall rather than suturing a plastic bag to the edge of the opened abdominal wall may be preferable for further reconstruction of the wall.