Abdominal Compartment Syndrome

The abdominal cavity is a closed anatomical space that extends from the thorax at the thoracic diaphragm to the pelvis.  The abdominal cavity contains the spleen, liver, kidneys, stomach, small intestines, large intestines, pancreas, aorta, gallbladder, diaphragm, the inferior vena cava, and the lower portion of the esophagus.  It is surrounded by the vertebrae, the diaphragm, the abdominal muscles, and the pelvic floor.

When the pressure within this closed anatomic space becomes elevated to the point of compromising capillary perfusion, a compartment syndrome occurs.  Any anatomic space that is closed is at risk of developing a compartment syndrome.  Abdominal compartment syndrome is a clinical spectrum of disease resulting from increased intra-abdominal pressure (IAP) that is due to tissue edema or free fluid collecting in the abdominal cavity.  Intra-abdominal hypertension (IAH) is what the elevated pressure in the abdomen is called.  Abdominal compartment syndrome is the last stage of organ failure that resulted from pathophysiologic derangements that resulted from the increased IAP.  The final stage of undetected and therefore untreated IAH is a multi-system organ failure and the death of the patient.

Conditions that result from high IAP include impairment of cardiac, pulmonary, renal, gastrointestinal, hepatic, and central nervous function.  The impact of IAH is not just limited to the intra-abdominal organs but also impacts all the organ systems in the body.

Unfortunately, sensitivity of clinical judgment and physical examination have been shown to be poor predictors of a patient’s IAP.  It is therefore essential for early serial IAP measurements to be done when diagnosing the presence of IAH in addition to guiding resuscitative therapy.  There are a variety of IAP measurement methods but intra-vesicular or bladder pressure have the most widespread adoption due to its simplicity, minimal cost, and low risk complications.

If any patient demonstrates significant elevations in IAP then immediate abdominal decompression should be performed.  This is best achieved in surgical patients by either creating or reopening the laparotomy incision and applying a temporary abdominal closure.

It is crucial that IAP be accurately and timely assessed to that both IAH and abdominal compartment syndrome can be diagnosed and managed.  Since elevated IAP may occur insidiously and clinical examination is oftentimes inaccurate in determining whether IAH is present, IAP measurements are very important.

The failure to diagnose IAH leading to abdominal compartment syndrome, multi-system organ failure, and patient death after surgery of the abdominal cavity may be considered medical malpractice.  Contact an experienced Kingston, New York medical malpractice attorney as soon as possible to evaluate your case.

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