Abdominal Compartment Syndrome

What is abdominal compartment syndrome?

Abdominal compartment syndrome (ACS) is a medical emergency that can occur in critically ill people. It happens when swelling and pressure in your belly (abdomen) reach dangerous levels.

Normal intra-abdominal pressure ranges between 0 and 5 millimeters of mercury (mmHg). In critically ill people, the range is between 5 and 7 mmHg. High intra-abdominal pressure may be defined as:

• Intra-abdominal hypertension (IAH), in which pressure is 12 to 20 mmHg.
• Abdominal compartment syndrome (ACS), in which pressure is higher than 20 mmHg.

Abdominal compartment syndrome can prevent your organs and muscles from getting enough blood and oxygen. This can lead to multi-organ failure and death, so it must be recognized and treated quickly.

Is abdominal compartment syndrome common?

Abdominal compartment syndrome is rare. It’s most often limited to people in critical condition in the hospital, usually the intensive care unit.

What causes abdominal compartment syndrome?

Abdominal compartment syndrome (ACS) occurs when bleeding or swelling causes pressure in your abdomen. Conditions that may cause such bleeding or pressure include:

• Extensive surgery in your abdomen.
• Infection in your abdomen.
• Intestinal obstruction (blockage).
• Large amount of IV fluids (called fluid resuscitation), often required for surgery or sepsis.
• Major burns.
• Massive blood transfusion.
• Pancreatitis.
• Rupture of an abdominal aortic aneurysm (a bulge in your aorta, the main blood vessel from your heart to your chest and belly).
• Trauma (injury) to your abdomen.

What are the symptoms of abdominal compartment syndrome?

The signs of abdominal compartment syndrome often appear late, after the syndrome has already caused damage. Healthcare providers must closely monitor people who are at risk for developing abdominal compartment syndrome.

Signs and symptoms may include:

• Swollen, tight belly (abdominal distension).
• Abdominal pain.
• Difficulty breathing.
• Low blood pressure (hypotension).
• Low pee (urine) output (oliguria).

How is abdominal compartment syndrome diagnosed?

People with abdominal compartment syndrome (ACS) may have:

• Low blood pressure.
• Low urine output.
• High peak pressures on a ventilator.

But the only way to confirm the diagnosis of ACS is to measure intra-abdominal pressure. Your healthcare provider will diagnose ACS if the pressure is higher than 20 mmHg and there’s evidence of organ failure.

The current method for measuring intra-abdominal pressure is to measure bladder pressure. Your healthcare provider will:

1. Insert a thin, flexible tube (catheter) into the tube that transports urine out of your body (urethra).
2. Advance the catheter to your bladder.
3. Attach the catheter to a bag of fluid.
4. Use a syringe to inject the fluid into your bladder.
5. Measure the pressure.

This test will be repeated so your healthcare team can tell if the condition is getting worse or better.

Your healthcare provider may also order certain tests to determine whether your organs are malfunctioning. These test may include:

• Blood tests: Blood tests can measure certain chemicals and gasses in your body. For example, a creatinine clearance test can measure your kidney function.
• Imaging tests: Imaging tests can provide pictures of the inside of your abdomen. For example, a CT scan or abdominal ultrasound.
• Oxygen saturation: This test uses a simple clamp on the outside of your finger to see whether your body is getting enough oxygen.

How is abdominal compartment syndrome treated?

The most effective abdominal compartment syndrome treatment is surgical decompression of your abdomen. Your surgeon will perform a procedure called decompressive laparotomy. They'll make a cut (incision) through your skin and abdominal wall to open the area and release pressure.

Intra-abdominal pressure decreases in the hours after surgery. But it may take several days for the pressure to reach a near-normal level. The incision may not be fully closed until this happens. Some people may require repeat abdominal decompression surgery.

Can abdominal compartment syndrome be prevented?

Intra-abdominal hypertension (IAH) may be managed without surgery. Nonsurgical treatments may keep IAH from progressing to abdominal compartment syndrome. These may include:

• Changing body positions to reduce pressure and make you more comfortable.
• Water pills (diuretics) to help your body get rid of excess fluid.
• Draining fluids from your abdomen through a tube.
• Emptying contents of your bowel (intestine) to relieve pressure and make more room in your abdomen.
• Managing pain with medications.
• Restricting fluids.

What is the outlook for people with abdominal compartment syndrome?

If abdominal compartment syndrome isn’t treated, it is fatal. Eventually, rising pressure in your abdomen causes more and more organs to shut down. The outlook is also poor if diagnosis and treatment are delayed.

But with early diagnosis and treatment, you can eventually recover from abdominal compartment syndrome.

Recovery from the original health problem can take weeks or months longer than ACS. You may need:

• Dialysis to do the work of your kidneys.
• Extended hospital stays.
• Fluid restrictions or diuretics.
• Heart monitoring.
• Mechanical ventilation to breathe.

A note from Cleveland Clinic

Abdominal compartment syndrome is a medical emergency that can occur in people with critical illness. It happens when swelling and pressure in your abdomen reach dangerous levels. Early diagnosis and treatment are essential to prevent severe complications and death.