Abdominal Compartment Syndrome and Emergency Decompressive Laparotomy

The Abdominal Compartment Syndrome (ACS) describes a life-threatening state, which requires immediate and often surgical intervention. ACS is defined by an elevated Intraabdominal Pressure (IAP, >20 mmHg) combined with failure of at least one organ system. The renal system is the first to be affected in most cases, but aggravating respiratory insufficiency, tachycardia, and arterial hypotension may also be apparent. Aside from abdominal trauma, a distinct capillary leak resulting from abdominal sepsis as well as a constrained compliance of the abdominal wall can facilitate intraabdominal hypertension (IAH) through to ACS. The abdomen may turn up firm, although clinical examination does not replace an IAP measurement, which is recommended indirectly via the bladder. In case of ACS and after the failure of conservative options, immediate surgical pressure relief by Emergency Decompressive Laparotomy (EDL) is mandatory to improve the outcome. This usually requires a temporary closure until a definitive closure is possible.