Abdominal compartment syndrome

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 2 Oct 2024

Last updated: 11 Nov 2022

Abdominal compartment syndrome is most commonly due to excessive fluid resuscitation (>5 L in 24 hours) or massive blood transfusion (>10 units in 24 hours).

Clinical signs are nonspecific and appear late. Classic findings are of increased airway pressure, decreased urine output, and a tense abdomen.

Diagnosis depends on proactive monitoring of intra-abdominal pressure (IAP) in patients with risk factors.

Medical options to decrease IAP include evacuation of intraluminal contents, optimization of fluid balance, correct body positioning, adequate analgesia, and, in severe cases, neuromuscular blockade.

Definitive treatment is surgical abdominal decompression; reserved for patients in whom medical interventions fail.

Fatal if left untreated. Even with treatment, mortality is high.

Definition

Abdominal compartment syndrome (ACS) is a sustained IAP over 20 mmHg, with or without an abdominal perfusion pressure below 60 mmHg, that is associated with new organ dysfunction or failure.[1]

History and exam

Key diagnostic factors

abdominal distension
oliguria
increased respiratory effort
hypotension

Full details

Risk factors

excessive fluid resuscitation (>3 L in 24 hours)
massive blood transfusion (>10 units in 24 hours)
decreased abdominal compliance
intra-abdominal infection/inflammation
hemoperitoneum
ileus
pneumoperitoneum
loss of abdominal domain
comorbid cirrhosis
retroperitoneal hematoma

Full details

Diagnostic tests

1st tests to order

transbladder measurement of intra-abdominal pressure
oxygen saturation
BUN and creatinine
arterial blood gases

Full details

Tests to consider

peak airway pressure
abdominal CT scan
abdominal ultrasound

Full details

Emerging tests

measurement of intra-abdominal pressure via vena cava, rectum, or abdominal cavity

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Michael W. Cripps, MD

Assistant Professor

Department of Surgery

Division of Burn/Trauma/Critical Care

University of Texas Southwestern Medical Center

Dallas

Disclosures

MWC has been reimbursed by Hemosonics and Instrumentation Laboratory for consultancy.

Jeffrey C. Perumean, MD

Surgeon/Surgical Intensivist

Advanced Surgical Associates/Banner Health

Division of Trauma/Critical Care

Mesa

Disclosures

JCP declares that he has no competing interests.

Acknowledgements

Dr Michael Cripps and Dr Jeffrey Perumean would like to gratefully acknowledge Dr Michaela West and Dr Gary An, previous contributors to this topic. MW and GA are authors of a reference cited in this topic.

Peer reviewers

Bart De Keulenaer, MD, FJFICM

Physician/Intensivist

Fremantle Hospital

Fremantle

Western Australia

Australia

Disclosures

BDK declares that he has no competing interests.

Differentials
- Shock
- Acute tubular necrosis
- Acute renal failure
More Differentials
Guidelines
- Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines
More Guidelines
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Abdominal compartment syndrome

Summary

Definition

History and exam

Key diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Emerging tests

Treatment algorithm

all patients

Contributors

Authors

Michael W. Cripps, MD

Disclosures

Jeffrey C. Perumean, MD

Disclosures

Acknowledgements

Peer reviewers

Bart De Keulenaer, MD, FJFICM

Disclosures

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

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