Abstract
Background
Intestinal obstruction (IO) leads to increased intra-abdominal pressure and abdominal compartment syndrome. The purpose of this study was to investigate the characteristics of abdominal compartment syndrome in patients with IO secondary to strangulated hernia.
Methods
We studied 81 consecutive unselected patients presenting complicated hernias and IO. We measured intra-abdominal pressure using the intra-vesicular pressure method.
Results
Preoperative (15 min) intra-abdominal pressure was higher in patients with strangulated hernias. Postoperative (15 min) intra-abdominal pressure in both groups decreased to similar values. Intra-abdominal pressure was measured during the preoperative period in patients with strangulated hernias and during the postoperative period at 15 min (13.8 ± 6.4 mmHg), 24 h (9.8 ± 3.2 mmHg) and 48 h (7.4 ± 2.4 mmHg). Abdominal compartment syndrome developed in 47% cases with strangulated hernias with a mortality of five patients.
Conclusions
Serial measurements of intra-abdominal pressure evidenced the clinical severity of strangulated hernia. Intra-abdominal pressure measurement may be used as a predictor of intestinal strangulation in patients presenting acute abdominal compartment syndrome secondary to complicated hernia.
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References
Schein M, Wittmann DH, Aprahamian CC, Condon RE (1995) The abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure. J Am Coll Surg 180:745–753
Burch JM, Moore EE, Moore FA, Franciose R (1996) The abdominal compartment syndrome. Surg Clin North Am 76:833–842
Saggi BH, Sugerman HJ, Ivatury RR, Bloomfield GL (1998) Abdominal compartment syndrome. J Trauma 45:597–608
Sieh KM, Chu KM, Wong J (2001) Intra-abdominal hypertension and abdominal compartment syndrome. Langenbecks Arch Surg 386:53–61
Peralta R, Hojman H (2001) Abdominal compartment syndrome. Int Anesthesiol Clin 39:75–94
Hong JJ, Cohn SM, Perez JM, Dolich MO, Brown M, McKenney MG (2002) Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 89:591–596
Bongard F, Pianim N, Dubecz S, Klein SR (1995) Adverse consequences on increased intra-abdominal pressure on bowel tissue oxygen. J Trauma 39:519–524
Fevang BT, Fevang J, Stangeland L, Soreide O, Svanes K, Viste A (2000) Complications and death after surgical treatment of small bowel obstruction: a 35-year institutional experience. Ann Surg 231:529–537
Arnell T, Stamos MJ (2001) Small bowel obstruction. Clin Colon Rectal Surg 14:69–78
Franklin ME, Gonzales JJ, Miter DB, Glass JL, Paulson D (2004) Laparoscopic diagnosis and treatment of intestinal obstruction. Surg Endosc 18:26–30
Fevang BT, Fevang J, Lie SA, Soreide O, Svanes K, Viste A (2004) Long-term prognosis after operation for adhesive small bowel obstruction. Ann Surg 240:193–201
Foster NM, McGory ML, Zingmond DS, Ko CY (2006) Small bowel obstruction: a population-based appraisal. J Am Coll Surg 203:170–176
Ihedioha U, Alani A, Modak P, Chong P, O’Dwyer PJ (2006) Hernias are the most common cause of strangulation in patients presenting with small bowel obstruction. Hernia 10:338–340
Beltrán MA, Cruces KS (2007) Primary tumors of Jejunum and Ileum as a cause of intestinal obstruction: a case control study. Int J Surg 5:183–191
Munegato G, Grigoletto R, Brandolese R (2000) Respiratory mechanics in abdominal compartment syndrome and large incisional hernias of the abdominal wall. Hernia 4:282–285
Kurt N, Oncel M, Ozkan Z, Bingul S (2003) Risk and outcome of bowel resection in patients with incarcerated groin hernias: retrospective study. World J Surg 27:741–743
Beltrán MA, Cruces KS (2007) Are the outcomes of emergency Lichtenstein hernioplasty similar to the outcomes of elective Lichtenstein hernioplasty? Int J Surg 5:198–204
Kron IL, Harman PK, Nolan SP (1984) The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg 199:28–30
Malbrain MLNG, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppäniemi A, Olvera C, Ivatury R, D’Amours S, Wendon J, Hillman K, Johansson K, Kolkman K, Wilmer A (2006) Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome: I. Definitions. Intensive Care Med 32:1722–1732
Cheatham ML, Malbrain MLNG, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppäniemi A, Olvera C, Ivatury R, D’Amours S, Wendon J, Hillman K, Wilmer A (2007) Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome: II. Recommendations. Intensive Care Med 33:951–962
Sanchez NC, Tenofsky PL, Dort JM, Shen LY, Helmer SD, Smith RS (2001) What is normal intra-abdominal pressure? Am Surg 67:243–248
Cobb WS, Burns JM, Kercher KW, Matthews BD, Norton JH, Heniford TB (2005) Normal intraabdominal pressure in healthy adults. J Surg Res 129:231–235
Meldrum DR, Moore FA, Moore EE, Franciose RJ, Sauaia A, Burch JM (1997) Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg 174:667–673
Ivatury RR, Diebel L, Porter JM, Simon RJ (1997) Intra-abdominal hypertension and the abdominal compartment syndrome. Surg Clin North Am 77:783–812
Sugrue M, Bauman A, Jones F, Bishop G, Flabouris A, Parr M, Stewart A, Hillman K, Deane SA (2002) Clinical examination is an inaccurate predictor of intraabdominal pressure. World J Surg 26:1428–1431
Alvarez JA, Baldonedo RF, Bear IG, Solis JA, Álvarez P, Jorge JI (2004) Incarcerated groin hernias in adults: presentation and outcome. Hernia 8:121–126
Rodríguez-Paz CA, Palacio-Vélez F (2000) Causas y mortalidad de la obstrucción intestinal en el anciano. Rev Gastroenterol Mex 65:121–123
Beltrán MA, Cruces KS, Tapia TFQ, Vicencio A (2006) Resultados quirúrgicos de la hernioplastía de Lichtenstein de urgencia. Rev Chil Cir 58:359–364
Hjaltason E (1981) Incarcerated hernia. Acta Chir Scand 147:263–267
Golub R, Cantu R (1998) Incarcerated anterior abdominal wall hernias in a community hospital. Hernia 2:157–161
Schachtrupp A, Höer J, Töns C, Klinge U, Reckord U, Schumpelick V (2002) Intra-abdominal pressure: a reliable criterion for laparostomy. Hernia 6:102–107
Schachtrupp A, Jansen M, Bertram P, Kuhlen R, Schumpelick V (2006) Abdominal compartment syndrome: significance, diagnosis and treatment. Anaesthesist 55:660–667
Bertram P, Schachtrupp A, Rosch R, Schumacher O, Schumpelick V (2006) Abdominal compartment syndrome. Chirurg 77:573–579
Wysocki A, Kulawik J, Pozniczek M, Srtzalka M (2006) Is the Lichtenstein operation of strangulated hernia a safe procedure? World J Surg 30:1065–1070
Lohsiriwat V, Sridermma W, Akaraviputh T, Boonnuch W, Chinsawangwatthanakol V, Methasate A, Lert-Akyamanee N, Lohsiriwat D (2007) Surgical outcomes of Lichtenstein tension-free hernioplasty for acutely incarcerated inguinal hernia. Surg Today 37:212–214
Bessa SS, Katri KM, Abdel-Salam WN, Abdel-Baki NA (2007) Early results from the use of the Lichtenstein repair in the management of strangulated groin hernia. Hernia 11:239–242
Campanelli G, Nicolosi FM, Pettinari D, Avesani EC (2004) Prosthetic repair, intestinal resection, and potentially contaminated areas: safe and feasible? Hernia 8:190–192
Abdel-Baki NA, Bessa SS, Abdel-Razek AH (2007) Comparison of prosthetic mesh repair and tissue repair in the emergency management of incarcerated para-umbilical hernia: a prospective randomized study. Hernia 11:163–167
Wysocki A, Pozniczek M, Krzywon J, Bolt L (2001) Use of polypropylene prostheses for strangulated inguinal and incisional hernias. Hernia 5:105–106
Acknowledgments
The authors would like to thank M.A. Contreras, M.D., for his helpful advice in the preparation of this manuscript.
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This work was read at the XVII Latin American surgical congress of FELAC (Latin American Surgical Federation) held in Santiago, Chile, 18–22 November 2007.
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Beltrán, M.A., Villar, R.A. & Cruces, K.S. Abdominal compartment syndrome in patients with strangulated hernia. Hernia 12, 613–620 (2008). https://doi.org/10.1007/s10029-008-0394-9
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DOI: https://doi.org/10.1007/s10029-008-0394-9