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Transverse laparostomy is feasible and effective in the treatment of abdominal compartment syndrome in severe acute pancreatitis.

Leppäniemi A, Mentula P, Hienonen P, Kemppainen E - World J Emerg Surg (2008)

Bottom Line: Immediately after decompression, the intra-abdominal pressure dropped from 23 mmHg to 10 mmHg, and the respiratory, cardiovascular and renal functions improved markedly leading to full recovery.It is feasible, effective and might provide a chance of early fascial closure.Comparative studies are needed to define its role as a decompressive technique for ACS.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Gastroenterological and General Surgery, Meilahti hospital, University of Helsinki, Helsinki, Finland. ari.leppaniemi@hus.fi.

ABSTRACT

Background: Only recently has the important role of abdominal compartment syndrome (ACS) been recognized as a contributing factor to the multiple organ failure commonly seen in severe acute pancreatitis (SAP). Decompressive laparostomy for ACS is a life-saving procedure usually performed through a midline incision followed by a negative pressure wound dressing. High risk of intestinal fistulas and frequent inability to close the fascia with ensuing planned ventral hernia has prompted the search for alternative techniques. Subcutaneous fasciotomy may be effective in early and less severe cases of ACS but it is always accompanied with a ventral hernia.

Case report: A patient with SAP developed manifest ACS and was treated with bilateral subcostal laparostomy. Immediately after decompression, the intra-abdominal pressure dropped from 23 mmHg to 10 mmHg, and the respiratory, cardiovascular and renal functions improved markedly leading to full recovery. The abdominal incision including the fascia and the skin was closed gradually over 4 relaparotomies, and during the 6 months' follow up there are no signs of ventral hernia or other wound complications.

Discussion: Transverse subcostal laparostomy is a promising alternative decompression technique for ACS in SAP. It is feasible, effective and might provide a chance of early fascial closure. Comparative studies are needed to define its role as a decompressive technique for ACS.

No MeSH data available.


Related in: MedlinePlus

CT scan on admission. Computed tomography on admission shows peripancreatic oedema, thickening of the Gerota's fascia on the left side and at least two poorly defined fluid collections (in other cuts) corresponding to severe acute pancreatitis with Balthazar grade E [21].
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Figure 1: CT scan on admission. Computed tomography on admission shows peripancreatic oedema, thickening of the Gerota's fascia on the left side and at least two poorly defined fluid collections (in other cuts) corresponding to severe acute pancreatitis with Balthazar grade E [21].

Mentions: A 29 years-old man with a medical history of traumatic cervical spine fracture (C6) managed operatively with full recovery and otherwise healthy presented to the emergency department with a one day history of epigastric pain and vomiting following excessive use of alcohol during the past 6 months. Based on physical examination (epigastric tenderness and guarding) and elevated plasma amylase levels (6 times normal upper limit), a diagnosis of alcohol-induced acute pancreatitis was made, the ultrasound examination revealed no gallstones or bile duct dilatation, and there was marked edema around the tail of the pancreas. The initial C-reactive protein level on admission was normal, but increased on the subsequent days to 205 mg/l (Day 1), and 271 mg/l (Day 2), respectively. The diagnosis and severity of acute pancreatitis were verified with a CT scan (Fig. 1). The initial treatment consisted of analgesics and intravenous crystalloid infusion and the patient was admitted to the emergency ward for observation.


Transverse laparostomy is feasible and effective in the treatment of abdominal compartment syndrome in severe acute pancreatitis.

Leppäniemi A, Mentula P, Hienonen P, Kemppainen E - World J Emerg Surg (2008)

CT scan on admission. Computed tomography on admission shows peripancreatic oedema, thickening of the Gerota's fascia on the left side and at least two poorly defined fluid collections (in other cuts) corresponding to severe acute pancreatitis with Balthazar grade E [21].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2266717&req=5

Figure 1: CT scan on admission. Computed tomography on admission shows peripancreatic oedema, thickening of the Gerota's fascia on the left side and at least two poorly defined fluid collections (in other cuts) corresponding to severe acute pancreatitis with Balthazar grade E [21].
Mentions: A 29 years-old man with a medical history of traumatic cervical spine fracture (C6) managed operatively with full recovery and otherwise healthy presented to the emergency department with a one day history of epigastric pain and vomiting following excessive use of alcohol during the past 6 months. Based on physical examination (epigastric tenderness and guarding) and elevated plasma amylase levels (6 times normal upper limit), a diagnosis of alcohol-induced acute pancreatitis was made, the ultrasound examination revealed no gallstones or bile duct dilatation, and there was marked edema around the tail of the pancreas. The initial C-reactive protein level on admission was normal, but increased on the subsequent days to 205 mg/l (Day 1), and 271 mg/l (Day 2), respectively. The diagnosis and severity of acute pancreatitis were verified with a CT scan (Fig. 1). The initial treatment consisted of analgesics and intravenous crystalloid infusion and the patient was admitted to the emergency ward for observation.

Bottom Line: Immediately after decompression, the intra-abdominal pressure dropped from 23 mmHg to 10 mmHg, and the respiratory, cardiovascular and renal functions improved markedly leading to full recovery.It is feasible, effective and might provide a chance of early fascial closure.Comparative studies are needed to define its role as a decompressive technique for ACS.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Gastroenterological and General Surgery, Meilahti hospital, University of Helsinki, Helsinki, Finland. ari.leppaniemi@hus.fi.

ABSTRACT

Background: Only recently has the important role of abdominal compartment syndrome (ACS) been recognized as a contributing factor to the multiple organ failure commonly seen in severe acute pancreatitis (SAP). Decompressive laparostomy for ACS is a life-saving procedure usually performed through a midline incision followed by a negative pressure wound dressing. High risk of intestinal fistulas and frequent inability to close the fascia with ensuing planned ventral hernia has prompted the search for alternative techniques. Subcutaneous fasciotomy may be effective in early and less severe cases of ACS but it is always accompanied with a ventral hernia.

Case report: A patient with SAP developed manifest ACS and was treated with bilateral subcostal laparostomy. Immediately after decompression, the intra-abdominal pressure dropped from 23 mmHg to 10 mmHg, and the respiratory, cardiovascular and renal functions improved markedly leading to full recovery. The abdominal incision including the fascia and the skin was closed gradually over 4 relaparotomies, and during the 6 months' follow up there are no signs of ventral hernia or other wound complications.

Discussion: Transverse subcostal laparostomy is a promising alternative decompression technique for ACS in SAP. It is feasible, effective and might provide a chance of early fascial closure. Comparative studies are needed to define its role as a decompressive technique for ACS.

No MeSH data available.


Related in: MedlinePlus