The value of intra-abdominal pressure measurement in patients with acute abdomen

To find out the potential benefit of bladder pressure (BP) measurement as a diagnostic tool for acute abdomen.

Acute abdomen is one of the most important clinical entities among general surgical clinics. The diagnosis can be achieved by considering the patient's history, physical examination, laboratory analysis or by different imaging modalities. Abdominal compartment syndrome (ACS) occurs due to elevated intra-abdominal pressure (IAP), and can be diagnosed by measurement of BP. We observed in our clinical routine elevated IAP levels in patients with acute abdomen.

Two groups were established: one containing 65 consecutive patients diagnosed as having acute abdomen in the emergency room, and the control group of 10 consecutive patients with no acute abdominal complaints elected for laparoscopic operation. IAP measurements were performed before the operations. BP was measured in the supine position with 50 mL of sterile saline instilled into the bladder after the bladder had been emptied. The catheter was connected to a water manometer with the reference point being the symphisis pubis. BP levels greater than 7 cmH2O were accepted as abnormal and interpreted as a diagnostic criteria for acute abdomen.

Sensitivity, specificity, positive predictive value, negative predictive value and the accuracy are calculated 95.4%, 80%, 96.9%, 72.7%, 93.3%, respectively.

We found elevated IAP may support the physicians diagnosis of acute abdomen with approximately 27.3% false negative rate.