[Intra-abdominal hypertension in patients with severe acute pancreatitis]

The role of parapancreatitis in the intra-abdominal hypertension (IAH) progression in patients with severe acute pancreatitis with various forms of organs failure was studied. It was analyzed the treatment results of 63 patients with severe acute pancreatitis. The patients were divided into 4 groups: the first group (n=24) had not the signs of organs failure, the second group (n=15) - with symptoms of acute respiratory failure (ARF), the third group (n=11) - with a combination of ARF and acute cardiovascular failure (CVF) and the fourth group (n=13) - with a combination of ARF, CVF and acute renal failure. Intra-abdominal pressure (IAP) was measured at 1, 3, 5, 7- days from the beginning of the disease with calculation of the abdominal perfusion pressure and filtration gradient values. The prevalence evaluation of parapancreatitis was carried out on the basis of CT-data with bolus-dosing of the contrast agent, ultrasound, video laparoscopy as well as data obtained during operation and autopsy. It was defined that the intra-abdominal pressure (IAP) values was not significantly different and complied with intra-abdominal hypertension of the first grade in patients of the groups 1-3 at the first day. IAP was significantly higher and complied with intra-abdominal hypertension of the second grade in patients of the fourth group. IAP normalized to 5-7th days in patients of the first and the second groups. The patients of the third and the fourth groups had IAH of the second grade in the 7th day. There was reliable (p<0.01) average positive correlation (r=0.57) between the indications of IAH and the scale APACHE II. The patients with common parapancreatitis (n=39) had indications of IAP and APACHE II significantly higher than in patients with local forms of parapancreatitis (n=24; p<0.01). Common defeat of retroperitoneal fat determined persistent increase of IAP more than the presence of effusion in the abdominal cavity. In case of the first grade of IAH the mortality was 6.6%, the second grade - 37.5%, the third grade - 58.3% and the fourth grade - 80%. All died patients had a common parapancreatitis. The authors consider that the indications of IAP and APACHE II let to suppose an adverse outcome by the development of multiple organ failure in the early stages of the disease. Common parapancreatitis is the main feature of the persistent IAH (IAP increase during 5-7 days), which is an indication for early decompression operations on the abdominal wall.