What should be the optimal route of artificial nutritional support in patients with abdominal compartment syndrome during severe acute pancreatitis?

Pancreatology ◽  
2016 ◽  
Vol 16 (3) ◽  
pp. S39
Author(s):  
Mihailo Bezmarevic ◽  
Marina Panisic-Sekeljic ◽  
Darko Mirkovic ◽  
Ana Popadic
Keyword(s):  
Acute Pancreatitis ◽  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Severe Acute Pancreatitis ◽  
Nutritional Support ◽  
Optimal Route ◽  
Abdominal Compartment

scholarly journals Abdominal compartment syndrome in severe acute pancreatitis (review of literature)

2020 ◽  
Vol 179 (2) ◽  
pp. 73-78
Author(s):  
L. A. Otdelnov ◽  
A. S. Mukhin
Keyword(s):  
Acute Pancreatitis ◽  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Severe Acute Pancreatitis ◽  
Medical Management ◽  
Abdominal Pressure ◽  
Decompressive Laparotomy ◽  
Russian Science Citation Index ◽  
Abdominal Hypertension ◽  
Abdominal Compartment

The study was performed for analysis of current understanding of intra-abdominal hypertension and abdominal compartment syndrome in patients with severe acute pancreatitis.The English and Russian articles about intra-abdominal hypertension and abdominal compartment syndrome in patients with severe acute pancreatitis were analyzed. The articles were found in «Russian Science Citation Index» and «PubMed».There is a pathogenetic relationship between increased intra-abdominal pressure and the development of severe acute pancreatitis.For today, it was shown that intra-abdominal hypertension in patients with severe acute pancreatitis is associated with significantly higher APACHE-II and MODS score, prevalence of pancreatic and peripancreatic tissue lesions, early infection of pancreatic necrosis and higher mortality.The article considers various variants of decompressive interventions such as decompressive laparotomy, fasciotomy and percutaneous catheter drainage. For today, there are no randomized studies devoted to researching effectiveness of different decompressive interventions.The study showed that it is necessary to regularly monitor intra-abdominal pressure in patients with severe acute pancreatitis. Patients with intra-abdominal hypertension require emergency medical management to reduce intra-abdominal pressure. Inefficiency of the medical management and development of abdominal compartment syndrome are indications for surgery. The effectiveness of different decompressive interventions requires further studies.

scholarly journals Interventional Treatment of Abdominal Compartment Syndrome during Severe Acute Pancreatitis: Current Status and Historical Perspective

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Dejan V. Radenkovic ◽  
Colin D. Johnson ◽  
Natasa Milic ◽  
Pavle Gregoric ◽  
Nenad Ivancevic ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Conservative Treatment ◽  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Severe Acute Pancreatitis ◽  
Fluid Resuscitation ◽  
Interventional Treatment ◽  
Invasive Approach ◽  
Aggressive Fluid Resuscitation ◽  
Abdominal Compartment

Abdominal compartment syndrome (ACS) in patients with severe acute pancreatitis (SAP) is a marker of severe disease. It occurs as combination of inflammation of retroperitoneum, visceral edema, ascites, acute peripancreatic fluid collections, paralytic ileus, and aggressive fluid resuscitation. The frequency of ACS in SAP may be rising due to more aggressive fluid resuscitation, a trend towards conservative treatment, and attempts to use a minimally invasive approach. There remains uncertainty about the most appropriate surgical technique for the treatment of ACS in SAP. Some unresolved questions remain including medical treatment, indications, timing, and interventional techniques. This review will focus on interventional treatment of this serious condition. First line therapy is conservative treatment aiming to decrease IAP and to restore organ dysfunction. If nonoperative measures are not effective, early abdominal decompression is mandatory. Midline laparostomy seems to be method of choice. Since it carries significant morbidity we need randomized studies to establish firm advantages over other described techniques. After ACS resolves efforts should be made to achieve early primary fascia closure. Additional data are necessary to resolve uncertainties regarding ideal timing and indication for operative treatment.

scholarly journals Interventional and surgical management of abdominal compartment syndrome in severe acute pancreatitis

Medicina ◽  
2010 ◽  
Vol 46 (4) ◽  
pp. 249 ◽  
Author(s):  
Žilvinas Dambrauskas ◽  
Audrius Paršeliūnas ◽  
Almantas Maleckas ◽  
Antanas Gulbinas ◽  
Giedrius Barauskas ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Surgical Management ◽  
Severe Acute Pancreatitis ◽  
Open Abdomen ◽  
Ultrasound Guided ◽  
Management Protocol ◽  
Fluid Collections ◽  
Abdominal Compartment

Background and objective. Management of the abdominal compartment syndrome during severe acute pancreatitis by the open abdomen method is associated with considerable morbidity and resource utilization. Thus, the aim of this study was to evaluate the safety and efficacy of the ultrasound-guided percutaneous interventions and/or minimally invasive surgery in the treatment of abdominal compartment syndrome. Material and methods. Forty-four patients with severe acute pancreatitis were enrolled into a prospective study and treated according to the standard management protocol. Interventional and/ or surgical management of abdominal compartment syndrome was employed in 6 (13.6%) cases. In the context of this study, we assessed the feasibility and effectiveness of subcutaneous fasciotomy of the anterior m. rectus abdominis sheath, as well as the role of ultrasound-guided drainage of intra-abdominal and peripancreatic fluid collections in the management of abdominal compartment syndrome. Results. Subcutaneous fasciotomy of the anterior m. rectus sheath and ultrasound-guided drainage of intra-abdominal and peripancreatic fluid collections seem to be safe (minor risk of bleeding or infection, closed abdomen, and easy care for the patient) and effective (resulted in a sustained decrease of intra-abdominal pressure to 13–16 mm Hg and regression of organ failures after intervention). Subcutaneous anterior m. rectus fasciotomy may appear to be beneficial in case of refractory abdominal compartment syndrome avoiding morbidity associated with the open abdomen technique. Conclusions. Both the subcutaneous fasciotomy and ultrasound-guided drainage of intra-abdominal and/or peripancreatic fluid collections seem to be safe and effective alternatives in the management of abdominal compartment syndrome; however, prospective studies are needed to further evaluate their clinical role.

scholarly journals Diagnosis and Choice of a Method of Treatment of Intraabdominal Hypertension and Abdominal Compartment Syndrome

2019 ◽  
Vol 74 (3) ◽  
pp. 210-215
Author(s):  
Vil M. Timerbulatov ◽  
Shamil V. Timerbulatov ◽  
Radik R. Fayazov ◽  
Mahmud V. Timerbulatov ◽  
Elza N. Gaynullina ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Conservative Treatment ◽  
Early Diagnosis ◽  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Severe Acute Pancreatitis ◽  
Abdominal Pressure ◽  
Decompressive Laparotomy ◽  
Abdominal Hypertension ◽  
Abdominal Compartment

BACKGROUND: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) remain a complex problem of abdominal surgery. To date, the pathophysiological mechanisms, methods for determining intra-abdominal pressure (IAP) the frequency of its measurement, and the methods of conservative and surgical more and more researchers consider surgical decompression as a treatment. AIMS: Аnalysis of the results of the implementation of monitoring of intra-abdominal pressure and its impact on the outcomes of treatment of patients with severe acute pancreatitis and acute colon obstruction. MATERIALS AND METHODS: A study of 397 patients with emergency abdominal pathology including 197 with acute obstructive obstruction of the colon (AOOC), 200 severe acute pancreatitis (SAP) was performed. Patients (n=201) were included in the I (main) group, which was carried out using IAP as the main criterion for assessing the patient`s condition and when choosing a method of treatment, in II ― without taking then into account and monitoring. Measurement of IAP, blood lactate was determined primarily, then alternatively 4 to 6 hours. The survey included the study of biochemical indicators, endoscopic methods, visualization (ultrasound scanning, CT of the abdominal cavity organs). RESULTS: In the I group of IAH patients, I and II degrees were in 73.13%, in the II group in 79.5% IAH III and IV degrees, respectively, in 26.87% and 21.5% (p0.05). Measurement of IAP was carried out according to the I.L. Kron method, repeated measurement depending on the degree of IAH after 46 hours, simultaneously, as a predictor of internal ischemia, determined the level of lactate in blood and perfusion abdominal pressure. An algorithm for early diagnosis is suggested excess intraabdominal pressure. For I and II, the degree of IAH was treated with aggressive conservative therapy, with failure of intensive therapy III of IAH degree surgical treatment, with IV degree IAH emergency decompressive laparotomy. In the I group, the mortality was significantly lower than in the II group: IAH at III, with AOOC 27.7% and 50%, respectively (p0.05), at SAP 37.5% and 80% (p0.01), respectively, at IV degree IAH for AOOC 75% and 90% (p0.05), with SAP 75% and 88,8% (p0.05) respectively. CONCLUSIONS: The results of treatment of patients with IAH can be improved by its early diagnosis, intensive, aggressive therapy of IAH IIII degrees. At IAH I, II degrees conservative treatment is shown, persistent aggressive conservative treatment should be performed at IAH III degree, if it is unsuccessful and IV degree of IAH, an emergency decompressive laparotomy should be performed.

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