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At least 433 records · Page 24Linked to original sources
PubMed2002

Abdominal compartment syndrome in children: CT findings.

Abdominal compartment syndrome (ACS) is caused by pathological elevation of intra-abdominal pressure (IAP) leading to multiple organ dysfunction syndrome. Since the condition is highly lethal, early diagnosis is imperative. We evaluated the pre-operative abdominal CT scans of three children with proven ACS to identify signs of elevated IAP. Findings common to these patients included narrowing of the inferior vena cava (IVC), direct renal compression or displacement, bowel wall thickening with enhancement and a rounded appearance of the abdomen. The aim of recognising the CT findings in such cases is to plan emergency surgical decompression. Although these findings are not specific for increased IAP, radiologists should be aware of this life-threatening condition and, in the proper clinical setting, should communicate the presence and significance of these findings to the referring clinician.

Abdomen↗
PubMed2004

Compartment syndrome of the thigh: an unusual complication after spinal surgery.

Compartment syndrome of the thigh is an uncommon pathology, and its acute presentation after spinal surgery is rare. Because a large muscle mass is involved and systemic manifestations of crush syndrome and altered mental status are present, such abnormalities may lead to a delay in appropriate diagnosis and subsequent treatment. A 56-year-old man who was suspected of having a posterior compartment syndrome in the thigh after spinal decompression in the knee-chest position was evaluated clinically and with the use of a catheter for intracompartmental pressure measurement as a tool to help establish the diagnosis and monitor the evolution. Because of sciatic involvement and a demonstrated increase in the pressure in the posterior compartment with myoglobinuria and acute renal failure, prompt longitudinal fasciotomy was performed with excellent neurologic recovery and improvement of both clinical parameters and mental status.

Compartment Syndromes↗
PubMed2006

[The abdominal compartment syndrome (ACS) in general surgery].

Mortality due to the abdominal compartment syndrome is extremely high (38-71%). It may be defined as adverse physiologic consequences that occur as a result of an acute increase in the intraabdominal pressure. The most common causes of abdominal compartment syndrome are retroperitoneal haemorrhage, visceral oedema, pancreatitis, bowel distension, venous mesenterial obstruction, tense ascites, peritonitis, tumor. The mostly affected organ systems include cardiovascular, pulmonary, renal, central nervous and splanchnic. The diagnosis depends on the recognition of the clinical syndrome followed by an objective measurement of intraabdominal pressure, preferably that of the urinary bladder. The treatment consist of adequate fluid resuscitation and surgical decompression when necessary.

Abdomen↗
PubMed2000

Laparoscopic decompression of abdominal compartment syndrome after blunt hepatic trauma.

Abdominal compartment syndrome (ACS) can occur in a variety of surgical conditions, particularly those with major life-threatening hemorrhage, massive volume resuscitation, prolonged operation times, and coagulopathy. In severely traumatized patients, the incidence of ACS is reported to be as high as 14% to 15% after damage control laparotomies. Although favorable results have been achieved with nonsurgical management of adult blunt hepatic trauma, the failure rates still range from 0% to 19%. Exploratory laparotomy is considered the intervention of choice in patients with blunt hepatic trauma who fail nonsurgical treatment. Expedient abdominal decompression currently is the treatment of choice after ACS. Oliguria, tachypnea, and tachycardia developed in two blunt hepatic trauma patients with grade IV and V injuries while they were receiving nonsurgical treatment. The intra-abdominal pressures measured more than 35 and 25 cm H 2O, respectively. Two patients with grade II and III ACS received laparoscopic examination instead of laparotomy. Their ACS was decompressed effectively via laparoscopy without any adverse effects. Therefore, we suggest that laparoscopy can be used as a safe alternative for the decompression of ACS.

Abdominal Injuries↗
PubMed2004

Near infrared spectroscopy in the diagnosis of chronic exertional compartment syndrome.

BACKGROUND: Patients with chronic exertional compartment syndrome (CECS) experience pain during exercise. An abnormal increase in intracompartmental pressure (ICP) leads to impaired local tissue perfusion resulting in ischemia and pain. At cessation of exercise, pain subsides. Diagnosis is confirmed through postexercise ICP. Near infrared spectroscopy (NIRS) can measure tissue oxygen saturation (StO(2)) noninvasively. HYPOTHESIS: NIRS can diagnose CECS by showing tissue deoxygenation. STUDY DESIGN: Prospective, nonrandomized clinical trial. METHOD: Volunteers completed a standardized exercise protocol. Those suspected of CECS did so preoperatively and postoperatively. StO(2) and ICP were monitored. Data were compared between volunteers and patients and prefasciotomy and postfasciotomy. RESULTS: Significant differences between the StO(2) values of volunteers and patients with CECS were found. Average peak exercise StO(2) value for those with CECS was lower than for the healthy (27 versus 56, P <.05). Patients showed more absolute and percentage change between baseline and peak exercise StO(2) (absolute: 60 versus 35, P <.05; percentage: 67 versus 38, P <.05). StO(2) values in legs with confirmed CECS returned to normal range postfasciotomy. All changes differed significantly with preoperative values. CONCLUSION: StO(2) can distinguish healthy from diseased legs. This study provides evidence supporting NIRS as a noninvasive, painless alternative to ICP in the diagnosis of CECS.

Adult↗
PubMed2006

Decompressive laparotomy for abdominal compartment syndrome--a critical analysis.

INTRODUCTION: Abdominal compartment syndrome (ACS) is increasingly recognized in critically ill patients, and the deleterious effects of increased intraabdominal pressure (IAP) are well documented. Surgical decompression through a midline laparotomy or decompressive laparotomy remains the sole definite therapy for ACS, but the effect of decompressive laparotomy has not been studied in large patient series. METHODS: We reviewed English literature from 1972 to 2004 for studies reporting the effects of decompressive laparotomy in patients with ACS. The effect of decompressive laparotomy on IAP, patient outcome and physiology were analysed. RESULTS: Eighteen studies including 250 patients who underwent decompressive laparotomy could be included in the analysis. IAP was significantly lower after decompression (15.5 mmHg versus 34.6 mmHg before, p < 0.001), but intraabdominal hypertension persisted in the majority of the patients. Mortality in the whole group was 49.2% (123/250). The effect of decompressive laparotomy on organ function was not uniform, and in some studies no effect on organ function was found. Increased PaO2/FIO2 ratio (PaO2 = partial pressure of oxygen in arterial blood, FiO2 = fraction of inspired oxygen) and urinary output were the most pronounced effects of decompressive laparotomy. CONCLUSION: The effects of decompressive laparotomy have been poorly investigated, and only a small number of studies report its effect on parameters of organ function. Although IAP is consistently lower after decompression, mortality remains considerable. Recuperation of organ dysfunction after decompressive laparotomy for ACS is variable.

Abdomen↗
PubMed2005

Effects of escharotomy as abdominal decompression on cardiopulmonary function and visceral perfusion in abdominal compartment syndrome with burn patients.

BACKGROUND: Abdominal compartment syndrome (ACS) can become fatal; however, it has rarely been described as a complication of burn injury. This study clarified the physiologic results of abdominal decompression (AD) for ACS in patients with burn injury in detail. METHODS: Extensively burned patients admitted to our burn unit between January 2003 and February 2004 were prospectively monitored by pulmonary artery catheter. Physiologic parameters from the catheter, blood gas analysis, intrabladder pressure as a parameter of intra-abdominal pressure (IAP), peak inspiratory pressure, and urine output (UO) were compared before and after escharotomy as AD in patients with ACS. RESULTS: Eight of 36 patients who had sustained more than 30% total body surface area burn developed ACS requiring AD in 18.3 +/- 4.9 hours. AD significantly decreased IAP (52 +/- 9 cm H2O vs. 26 +/- 7 cm H2O), peak inspiratory pressure (53 +/- 13 cm H2O vs. 35 +/- 6 cm H2O), heart rate, and Paco2, and increased cardiac index (1.6 +/- 0.7 L/min/m2 vs. 2.5 +/- 0.9 L/min/m2), abdominal perfusion pressure (50 +/- 11 mm Hg vs. 72 +/- 17 mm Hg), UO (0.45 +/- 0.46 mL/h/kg vs. 2.0 +/- 2.1 mL/h/kg), and oxygen delivery index (290 +/- 195 mL/m2/min vs. 455 +/- 218 mL/m2/min). Impaired oxygen consumption index increased (86 +/- 43 mL/m2/min vs. 153 +/- 58 mL/m2/min) after AD. CONCLUSION: In patients with severe burn injury, elevated IAP makes pulmonary artery wedge pressure and UO unreliable indices of preload or intravascular volume, and decreases abdominal perfusion in the resuscitation period. AD in these patients significantly improves the ventilation, hemodynamic parameters, and oxygen metabolism.

Abdomen↗
PubMed1987

Compartment syndrome resulting from intravenous regional anesthesia.

Three cases of iatrogenic compartment syndrome of the upper extremity are reported. Each was the result of the use of hypertonic saline solution in the administration of intravenous regional anesthesia. Two patients were left with residual problems after resolution of the compartment syndrome despite early surgical intervention in one of these cases. This mechanism may explain other previously reported occurrences of severe swelling in an extremity after intravenous regional anesthesia.

Adult↗
PubMed2004

Modified extraperitoneal endoscopic separation of parts for abdominal compartment syndrome.

BACKGROUND: Standard therapy for abdominal compartment syndrome (ACS) is laparotomy and temporary abdominal wall closure with significant morbidity. The component separation technique allows for difficult abdominal closure. We studied a modified extraperitoneal endoscopic separation of parts technique on an animal model of ACS. METHODS: Twelve anesthetized pigs were instrumented for measurement of central venous pressure, arterial pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac output, and intraabdominal pressure (IAP). ACS to 25 mmHg was created by infusing saline into an intraabdominally placed bag. Animals were divided in two equal groups. Pigs in group A underwent minimally invasive resection of the nerves supplying the rectus muscles bilaterally. Pigs in group B underwent minimally invasive modified component separation technique bilaterally. Change in IAP and other physiological parameters were recorded. RESULTS: (Group A) IAP increased significantly from 7.3 mmHg +/- 3.8 to 25.2 mmHg +/- 1.5 with infusion of saline. Following nerve transection on the right side there was a nonsignificant decrease in IAP from 25.2 mmHg +/- 1.5 to 22.3 mmHg +/- 1.4 and following nerve transection on the left side there was a further decrease in IAP to 20.3 mmHg +/- 1.9. (Group B) IAP increased significantly from 3.8 mmHg +/- 0.4 to 24.7 mmHg +/- 0.5 with infusion of saline. Following separation of parts on the right side there was a significant decrease in IAP from 24.7 mmHg +/- 0.5 to 15.0 mmHg +/- 1.7 and there was a further decrease in IAP to 11.3 mmHg +/- 1.4 following separation of parts on the left side. The only significant change in the physiological parameters measured was observed in CVP in both groups. CONCLUSION: We present a porcine model of extraperitoneal endoscopic release of abdominal wall components as a treatment option for ACS.

Abdomen↗
PubMed2001

Compartment syndrome of the calf and foot following a displaced Salter-Harris type II fracture of the distal tibia: a review of the literature and a case report.

A 14 year-old boy with an epiphyseal fracture of the distal right tibia and fibula developed compartment syndrome of the calf and foot. The diagnosis of compartment syndrome was delayed and a fasciotomy resulted in uncontrolled infection, which ultimately resulted in an above knee amputation. Constant vigilance is necessary in uncooperative or non-complaining patients to detect the signs and symptoms of compartment syndrome, even where the injury is not often associated with this complication. The difficulties in management, following a fasciotomy for delayed diagnosis of compartment syndrome, are discussed.

Adolescent↗
PubMed1997

[Acute compartment syndrome of the tibia--complication of popliteal artery aneurysm].

The compartment syndrome is a common complication in the traumatology of the lower limb. In vascular surgery it is observed following emergency revascularisation. It is a rare condition as an initial symptom of a peripheral clotted aneurysm. By means of a case with a complicated popliteal aneurysm the differential diagnosis of the non-traumatologic compartment syndrome is discussed.

Adult↗
PubMed1998

Chronic exertional compartment syndrome: MR imaging at 0.1 T compared with tissue pressure measurement.

PURPOSE: To compare low-field-strength magnetic resonance (MR) imaging with intracompartmental tissue pressure measurement for the diagnosis of chronic exertional compartment syndrome. MATERIALS AND METHODS: Thirteen patients suspected clinically of having chronic exertional compartment syndrome in the anterior tibial compartment were studied. MR imaging at 0.1-T and intracompartmental tissue pressure measurements of the anterior tibial compartment were performed before and immediately after standard treadmill exercise. The MR measurements were also obtained in eight anterior tibial compartments of four control subjects without the syndrome. Intracompartmental signal intensity was normalized with the signal intensity from lower leg tissues not affected by the compartment syndrome (subcutaneous fat, tibial bone marrow, or superficial posterior compartment). RESULTS: In the patient group, the relative change from rest to the postexercise state in the normalized MR signal intensity parameter correlated significantly (P < .001) with the respective change in intracompartmental pressure and with the absolute postexercise pressure. In the patients with elevated postexercise intracompartmental pressure, the increase in normalized MR signal intensity from rest to the postexercise state was significantly greater (P < .01) than that in the control subjects or the patients with normal or borderline postexercise intracompartmental pressure. In the latter two groups, the MR results were comparable. CONCLUSION: MR imaging performed at rest and immediately after muscular exercise is a promising method for diagnosing chronic exertional compartment syndrome and assessing its severity.

Adult↗
PubMed1997

Neutrophil mediated microvascular injury in acute, experimental compartment syndrome.

The purpose of this study was to determine the contribution of neutrophils and tissue xanthine oxidase to the skeletal muscle microvascular dysfunction in an ex vivo model of acute compartment syndrome. Adult dogs were rendered neutropenic or depleted of tissue xanthine oxidase before gracilis muscle isolation. Compared with continuously perfused, nonischemic muscles, acute, experimental compartment syndrome resulted in a dramatic increase in microvascular permeability, muscle neutrophil content, and muscle vascular resistance. Neutropenia prevented, whereas xanthine oxidase depletion had no effect on, the microvascular dysfunction and muscle neutrophil infiltration elicited by experimental compartment syndrome. These results suggest that neutrophils contribute to the microvascular dysfunction and blood flow distribution abnormalities elicited by acute, experimental compartment syndrome.

Acute Disease↗
PubMed2003

The medial brachial fascial compartment syndrome following axillary arteriography.

OBJECTIVE: To review clinical and electrodiagnostic features of the medial brachial fascial compartment syndrome, a complication of percutaneous axillary vessel puncture. METHODS: The authors reviewed electrodiagnostic examinations over a 20-year period. RESULTS: This syndrome presents with weakness, pain, and numbness during or following the percutaneous procedure. Injury is characterized by axon loss and involves terminal nerves of the infraclavicular brachial plexus-most often the median nerve alone, followed by combinations of the median, ulnar, radial, and musculocutaneous nerves. CONCLUSIONS: Early recognition of the medial brachial fascial compartment syndrome may lead to prompt surgical intervention, which, in turn, may prevent permanent nerve injury. Late diagnosis generally results in poor outcome and often results from delayed symptom onset and lack of overt compartment syndrome signs.

Action Potentials↗
PubMed1989

Are free radical scavengers beneficial in the treatment of compartment syndrome after acute arterial ischemia?

Because it is postulated that compartment syndrome developing secondary to an acute arterial occlusion may be due to reperfusion injury, oxygen-derived free radicals have been implicated in its genesis. To assess the possible beneficial effect of free radical scavengers in this setting, we used a previously established in vivo canine model of compartment syndrome to compare four groups: group I, no treatment; group II, prophylactic fasciotomy; group III, intravenous albumin conjugated superoxide dismutase (SOD); group IV, intravenous mannitol (hydroxyl radical scavenger). Both hind limbs were completely devascularized at the popliteal level except for an isolated pedicle to the anterior compartment. The right limb served as the nonischemic control, whereas the left underwent 8 hours of ischemia followed by reperfusion. Continuous monitoring of transfascial oxygen tension (tfPO2) demonstrated severe ischemia during occlusion (tfPO2 5.7 +/- 5.1 mm Hg) and restoration of blood flow with reperfusion (mean tfPO2 50 to 60 mm Hg). Measurements of compartment pressure were significantly higher after reperfusion in groups I, III, and IV when compared with those of group II (p less than 0.001, groups I and II; p less than 0.01, group IV). Extent of muscle necrosis assessed by technetium pyrophosphate scanning and expressed as a ratio of left to right legs was as follows: group I, 8.9 +/- 5.0; group II, 2.6 +/- 0.5; group III, 2.8 +/- 0.8; group IV, 1.8 +/- 0.6. Muscle contraction studies 16 hours after reperfusion indicated abnormal findings in all but group II. In conclusion, administration of free radical scavengers did not preserve normal neuromuscular function despite a significant reduction in muscle damage.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Pneumatic antishock garment-associated compartment syndrome in uninjured lower extremities.

Pneumatic antishock garment-associated compartment syndrome is a rare and yet underrecognized complication that when it occurs, frequently results in myonecrosis and loss of limb function, and occasionally loss of a limb or even death. We report a case of pneumatic antishock garment-associated compartment syndrome in a trauma patient without lower extremity injury and review similar published reports. It is only with a high index of suspicion, early recognition, and prompt treatment of this complication by fasciotomy and proper wound care that associated morbidity and potential mortality of this complication can be prevented or minimized.

Abdominal Injuries↗
PubMed2006

Use of a fascial prosthesis for management of abdominal compartment syndrome secondary to obstetric hemorrhage.

BACKGROUND: Massive obstetric hemorrhage can be catastrophic, with considerable maternal morbidity and mortality. CASE: A 41-year-old term gravida experienced massive postpartum hemorrhage attributed to an amniotic fluid embolism with rapid development of disseminated intravascular coagulation and resultant abdominal compartment syndrome. In this critically ill patient, a fascial prosthesis used for abdominal wall closure was placed to expedite multiple abdominal explorations and packing. Additionally, this device facilitated fascial closure once the abdominal compartment syndrome was resolved. CONCLUSION: Abdominal compartment syndrome resulting from overwhelming obstetric hemorrhage may necessitate emergent decompressive laparotomy to alleviate increased intra-abdominal pressure and end-organ dysfunction. The fascial prosthesis allows a staged abdominal wall closure to be performed once the abdominal compartment syndrome is resolved.

Abdomen↗