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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

Completed laparostomy. Patches of liponecrosis seen on the surface of the greater omentum.
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Figure 3: Completed laparostomy. Patches of liponecrosis seen on the surface of the greater omentum.

Mentions: Because of increasing severity of organ dysfunction in spite of maximal supportive care and elevated IAP, a diagnosis of ACS was made and a decompressive laparostomy was performed 38 hours post-admission. A bilateral, wide subcostal incision about 5 cm below the costal margins was made and the fascial and muscle layers extending to about 5–8 cm lateral to the rectus sheats were divided on both sides (Fig. 2). Immediately before the incision, the IAP measured on the table was 23 mmHg dropping to 10 mmHg immediately after, before extensive drainage of ascites (about 2 liters). Simultaneously without changing the ventilator set up, the tidal volume increased from 400 to 500 ml, and the mean arterial pressure about 10 mmHg. The abdomen or peripancreatic area were not explored further (Fig. 3) and the viscera were covered with a negative pressure dressing. Back at the SICU a renal replacement therapy was started.


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)

Completed laparostomy. Patches of liponecrosis seen on the surface of the greater omentum.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Completed laparostomy. Patches of liponecrosis seen on the surface of the greater omentum.
Mentions: Because of increasing severity of organ dysfunction in spite of maximal supportive care and elevated IAP, a diagnosis of ACS was made and a decompressive laparostomy was performed 38 hours post-admission. A bilateral, wide subcostal incision about 5 cm below the costal margins was made and the fascial and muscle layers extending to about 5–8 cm lateral to the rectus sheats were divided on both sides (Fig. 2). Immediately before the incision, the IAP measured on the table was 23 mmHg dropping to 10 mmHg immediately after, before extensive drainage of ascites (about 2 liters). Simultaneously without changing the ventilator set up, the tidal volume increased from 400 to 500 ml, and the mean arterial pressure about 10 mmHg. The abdomen or peripancreatic area were not explored further (Fig. 3) and the viscera were covered with a negative pressure dressing. Back at the SICU a renal replacement therapy was started.

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