Surgical decompression for abdominal compartment syndrome in severe acute pancreatitis.

  • Mentula P
  • Hienonen P
  • Kemppainen E
 et al. 
  • 25

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Abstract

HYPOTHESIS: In patients with severe acute pancreatitis and abdominal compartment syndrome, establishment of the indications and optimal time for surgical decompression may avoid exacerbation of multiple-organ dysfunction syndrome. DESIGN: Retrospective study. SETTING: Tertiary care university teaching hospital. PATIENTS: Twenty-six consecutive patients with severe acute pancreatitis and abdominal compartment syndrome treated by surgical decompression between January 1, 2002, and December 31, 2007. INTERVENTION: Surgical decompression of the abdomen. MAIN OUTCOME MEASURES: Morbidity, mortality, and organ dysfunction before and after surgical decompression. RESULTS: At the time of surgical decompression, the median sequential organ failure assessment score among patients was 12 (interquartile range, 10-15), and the median intra-abdominal pressure was 31.5 (interquartile range, 27-35) mm Hg. After surgical decompression, renal or respiratory function was improved in 14 patients (54%). The overall hospital mortality was 46%, but mortality was 18% among 17 patients in whom surgical decompression was performed within the first 4 days after disease onset. CONCLUSIONS: Patients with severe acute pancreatitis and abdominal compartment syndrome managed by surgical decompression had severe multiple-organ dysfunction syndrome and high mortality. Surgical decompression may improve renal or respiratory function. Early surgical decompression is associated with reduced mortality in patients with severe acute pancreatitis, early multiple-organ dysfunction syndrome, and abdominal compartment syndrome.

Author-supplied keywords

  • Abdomen
  • Adult
  • Compartment Syndromes
  • Compartment Syndromes: etiology
  • Compartment Syndromes: mortality
  • Compartment Syndromes: surgery
  • Decompression
  • Disease Progression
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Multiple Organ Failure
  • Multiple Organ Failure: prevention & control
  • Pancreatitis
  • Pancreatitis: complications
  • Pancreatitis: mortality
  • Reoperation
  • Reoperation: statistics & numerical data
  • Retrospective Studies
  • Risk Factors
  • Surgical
  • Time Factors

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Authors

  • Panu Mentula

  • Piia Hienonen

  • Esko Kemppainen

  • Pauli Puolakkainen

  • Ari Leppäniemi

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