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.^{[27, 28, 29, 30, 33, 39, 40]}

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

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

Differential Diagnoses

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Abdominal Compartment Syndrome Clinical Presentation

History

Physical Examination

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