TITLE

Hyperacute Abdominal Compartment Syndrome: An Unrecognized Complication of Massive Intraoperative Resuscitation for Extra-abdominal Injuries

AUTHOR(S)
Rodas, Edgar B.; Malhotra, Ajai K.; Chhitwal, Reena; Aboutanos, Michel B.; Duane, Therese M.; Ivatury, Rao R.
PUB. DATE
November 2005
SOURCE
American Surgeon;Nov/2005, Vol. 71 Issue 11, p977
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Primary and secondary abdominal compartment syndrome (ACS) are well-recognized entities after trauma. The current study describes a "hyperacute" form of secondary ACS (HACS) that develops intraoperativety while repair of extra-abdominal injuries is being carried out simultaneous with massive resuscitation for shock caused by those injuries. The charts of patients requiring abdominal decompression (AD) for HACS at time of extra-abdominal surgery at our level I trauma center were reviewed. The following data was gathered: age. Injury Severity Score (ISS), mechanism, resuscitation details, time to AD, time to abdominal closure, and outcome. All continuous data are presented as mean ± standard error of mean. Hemodynamic and ventilatory data pre- and post-AD was compared using paired t test with significance set at P < 0.05. Five (0.13%) of 3,750 trauma admissions developed HACS during the 15-month study period ending February 2004. Mean age was 32 ± 7 years, and mean ISS was 19 ± 2. Four of five patients arrived in hemorrhagic shock (blunt subclavian artery injury, 1; chest gunshot, 1; gunshot to brachial artery, 1; stab transection of femoral vessels, 1) and were immediately operated upon. One of five patients (70% burn) developed HACS during burn wound excision on day 2. HACS developed after massive crystalloid (15 ± 1.7 L) and blood (11 ± 0.4 units) resuscitation during prolonged surgery (4.8 ± 0.8 hours). Pre- versus post-AD comparisons revealed significant (P < 0.05) improvements in mean arterial pressure (55 ± 6 vs 88 ± 3 mm Hg), peak airway pressure (44 ± 5 vs 31 ± 2 mm Hg), tidal volume (432 ± 96 vs 758 ± 93 mL), arterial pH (7.16 ± 0.0 vs 7.26 ±0.04), and PaCO2 (52 ± 6 vs 45 ± 6 mm Hg). There was no mortality among the group, and all patients underwent abdominal closure by fascial reapproximation in 2-5 days. Two (40%) of the five patients required extremity fasciotomy for compartment syndrome. HACS is a rare complication of massive resuscitation for extra-abdominal injuries. It should be considered in such patients in the face of unexplained hemodynamic and/or ventilatory decompensation. Prompt AD is life saving. Early abdominal closure is usually possible. Vigilance for compartment syndromes elsewhere in the body is warranted in any patient with HACS.)
ACCESSION #
18904506

 

Related Articles

  • Blunt Hollow Viscus and Mesenteric Injury: Still Underrecognized. Matsushima, Kazuhide; Mangel, Patricia; Schaefer, Eric; Frankel, Heidi // World Journal of Surgery;Apr2013, Vol. 37 Issue 4, p759 

    Background: Despite the availability of more accurate imaging modalities, specifically multidetector computed tomography (MDCT), the diagnosis of non-ischemic (NI-) and ischemic (I-) blunt hollow viscus and mesenteric injury (BHVMI) remains challenging. We hypothesized that BHVMI can be still...

  • Protocol for Bedside Laparotomy in Trauma and Emergency General Surgery: A Low Return to the Operating Room. Diaz Jr., Jose J.; Mejia, Vicente; Subhawong, Andrea Proctor; Subhawong, Ty; Miller, Richard S.; O'Neill, Patrick J.; Morris Jr., John A. // American Surgeon;Nov/2005, Vol. 71 Issue 11, p986 

    Bedside laparotomy (BSL) was introduced as a heroic procedure in trauma patients too unstable for safe transport to the operating room (OR). We hypothesize a BSL protocol would maintain patient safety while reducing OR use. Patients were prospectively entered into a BSL protocol from July 2002...

  • Aortic Occlusion Balloon Catheter Technique Is Useful for Uncontrollable Massive Intraabdominal Bleeding After Hepato-Pancreato-Biliary Surgery Miura, Fumihiko; Takada, Tadahiro; Ochiai, Takenori; Asano, Takehide; Kenmochi, Takashi; Amano, Hodaka; Yoshida, Masahiro // Journal of Gastrointestinal Surgery;Apr2006, Vol. 10 Issue 4, p519 

    Massive intraabdominal hemorrhage sometimes requires urgent hemostatic surgical intervention. In such cases, its rapid stabilization is crucial to reestablish a general hemodynamic status. We used an aortic occlusion balloon catheter in patients with massive intraabdominal hemorrhage occurring...

  • Pre-hospital transport times and survival for Hypotensive patients with penetrating thoracic trauma. Swaroop, Mamta; Straus, David C.; Agubuzu, Ogo; Esposito, Thomas J.; Schermer, Carol R.; Crandall, Marie L. // Journal of Emergencies, Trauma & Shock;Jan-Mar2013, Vol. 6 Issue 1, p16 

    Background: Achieving definitive care within the "Golden Hour" by minimizing response times is a consistent goal of regional trauma systems. This study hypothesizes that in urban Level I Trauma Centers, shorter pre-hospital times would predict outcomes in penetrating thoracic injuries. Materials...

  • Clinical Experiences of Transarterial Embolization after Abdominal Surgery in Trauma Patients. Min Jung Hwang; Ho Kyun Lee; Soo Jin Na Choi; Sang Young Chung // Korean Journal of Vascular & Endovascular Surgery;Nov2012, Vol. 28 Issue 4, p196 

    Purpose: Transarterial embolization has been known as an effective nonsurgical treatment for selected patients with intraabdominal hemorrhage. This study was conducted to evaluate the clinical outcomes of transarterial embolization after emergency operation in the blunt abdominal trauma patients...

  • What is the optimal observation time for a penetrating wound to the flank? Macleod, Jana; Freiberger, Doug; Lewis, Fran; Feliciano, David // American Surgeon;Jan2007, Vol. 73 Issue 1, p25 

    Options for a hemodynamically stable patient with a penetrating wound to the flank or back but no peritonitis, includes serial physical examinations versus a triple-contrast CT scan. There is, however, little consensus on the minimum time for serial examinations to exclude an injury that...

  • Traumatische thorakale Aortenruptur. R. Kopp; J. Andrassy; S. Czerner; A. Weidenhagen; R. Weidenhagen; G. Meimarakis; M. Reiser; K.W. Jauch // Anaesthesist;Aug2008, Vol. 57 Issue 8, p782 

    Zusammenfassung  Die traumatische thorakale Aortenruptur stellt eine lebensbedrohliche Verletzung der Aorta dar, die als Begleitverletzung nach stumpfem Thoraxtrauma oder im Rahmen eines Polytraumas vorkommen kann. In Abhängigkeit vom Ausmaß der Zerreißung der Aortenwand ist diese...

  • Surgical Complications and Causes of Death in Trauma Patients That Require Temporary Abdominal Closure. Montalvo, José A.; Acosta, José A.; Rodríguez, Pablo; Alejandro, Kathia; Sárraga, Andrés // American Surgeon;Mar2005, Vol. 71 Issue 3, p219 

    Temporary abdominal closure (TAC) has increasingly been employed in the management of severely injured patients to avoid abdominal compartment syndrome (ACS) and as part of damage control surgery (DCS). Although the use of TAC has received great interest, few data exist describing the morbidity...

  • Traumatic bilateral carotid and vertebral artery dissection. Koleilat, Issam; Gandhi, Ravi; Boulos, Alan; Bonville, Daniel // Journal of Emergencies, Trauma & Shock;Jan-Mar2013, Vol. 7 Issue 1, p47 

    The article presents a case study of a 23-year-old woman who was taken to the trauma center after a car accident. It states that the patient had cervical transverse process fractures, basal ganglia and right caudate infarction, left temporal lobe contusion and a left mandibular fracture. It also...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics