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Abdominal Compartment Syndrome Clinical Presentation

  • Author: Richard Paula, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: Sep 15, 2015
 

History

The history varies depending on the cause of abdominal compartment syndrome, but abdominal pain is commonly present. Abdominal pain may precede the development of abdominal compartment syndrome and may be directly related to a precipitating event, such as blunt abdominal trauma or pancreatitis.

Syncope or weakness may be a sign of hypovolemia. Although abdominal pain and distention are commonly present, patients may not experience abdominal pain. Difficulty breathing or decreased urine output may be the first signs of intra-abdominal hypertension (IAH).

Furthermore, patients who develop abdominal compartment syndrome may be unable to communicate, because they are often intubated and critically ill.

Signs and symptoms can include the following:

  • Increase in abdominal girth
  • Difficulty breathing
  • Decreased urine output
  • Syncope
  • Melena
  • Nonsteroidal anti-inflammatory drug (NSAID) use
  • Alcohol abuse
  • Nausea and vomiting
  • History of pancreatitis

Abdominal compartment syndrome may be obscured in patients with critical injuries. Failure to consider abdominal compartment syndrome prevents diagnosis and treatment. Many disease processes can contribute to abdominal compartment syndrome. Consider IAH and document intra-abdominal pressures in any of the following patients:

  • Intubated patients who have high peak and plateau pressures and are difficult to ventilate
  • Patients who have GI bleeding or pancreatitis and are not responding to intravenous (IV) fluids, blood products, and pressors
  • Patients who have severe burns or sepsis with decreasing urine output and are not responding to IV fluids and pressors
  • Any patient with contradictory Swann-Ganz readings
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Physical Examination

Compartment syndrome in the abdomen is usually suggested by an increased abdominal girth. If this change is acute, the abdomen is tense and tender. Although this may be difficult to recognize in patients with morbid obesity, other patients often have an abdomen clearly out of proportion to their body habitus. This may be easier to visualize with the patient standing or sitting upright.

In addition to distended abdomen, other secondary effects of abdominal compartment syndrome are as follows:

  • Wheezes, rales, increased respiratory rate
  • Cyanosis
  • Wan appearance

Complications

Abdominal compartment syndrome itself can involve almost any organ system, as described in the following:

  • Renal failure: This is not prevented by intraureteral stents, which suggests direct compression of renal parenchyma and decreased renal perfusion as causes
  • Respiratory distress and failure: Initial signs of abdominal compartment syndrome include elevated peak airway pressures in intubated patients with decreased tidal volumes
  • Bowel ischemia
  • Increased intracranial pressure (ICP): Decompressive laparotomy has been shown to reduce intractable elevated ICP in patients with IAH
  • Failing cardiac output and refractory shock: Abdominal compartment syndrome factitiously elevates central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) in patients who are hypovolemic or euvolemic
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Contributor Information and Disclosures
Author

Richard Paula, MD Chief Medical Informatics Officer, Shriners Hospitals for Children; Assistant Professor of Emergency Medicine, University of South Florida College of Medicine

Richard Paula, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eddy S Lang, MDCM, CCFP(EM), CSPQ Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary Faculty of Medicine; Assistant Professor, Department of Family Medicine, McGill University Faculty of Medicine, Canada

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, Canadian Association of Emergency Physicians

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

James Li, MD Former Assistant Professor, Division of Emergency Medicine, Harvard Medical School; Board of Directors, Remote Medicine

Disclosure: Nothing to disclose.

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