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PubMed2005

Secondary abdominal compartment syndrome: risk factors and outcomes.

Secondary abdominal compartment syndrome (ACS), defined as intra-abdominal hypertension with associated pulmonary, renal, or hemodynamic compromise in the absence of preceding abdominal operation or injury, can markedly increase surgical morbidity and mortality. We performed a retrospective chart review of the physiologic parameters and outcomes of 10 patients with secondary ACS. Ten patients developed secondary ACS after aggressive resuscitation, at an average of 20.2 hours. Four of the patients sustained burns greater than 40 per cent, three of the patients had penetrating extremity trauma, one patient had blunt abdominal trauma, one patient was struck by lightning, and one patient developed a retroperitoneal bleed while on heparin. The average bladder pressure was 40.6. The average volume given in the first 24 hours was 33,001 cc (range, 12,400 to 69,000). The average base deficit at admission was -12 (range, +1 to -25). Seven of the 10 patients had decreased urine output. Nine of the 10 patients had decreased tidal volumes on pressure control ventilation. All 10 patients were hypotensive, with 7 of the 10 requiring vasopressors. Overall mortality was 60 per cent, with 43 per cent mortality for those decompressed. Prompt recognition and treatment are mandatory for survival of ACS. We recommend routine bladder pressure monitoring for patients with ongoing resuscitation greater than 500 cc/hr.

Abdomen↗
PubMed2004

[Abdominal compartment syndrome: patophysiologic and clinic remarks].

The abdominal compartment syndrome is a high grade abdominal hypertension with clinical evidence of multiorgan failure (MOF). It is more and more frequently observed in intensive-care units as a complication in critical patients, but especially in traumatology and surgery. The incidence is highly variable according to the different trials but the severity of scores is the common factor. All the possible mechanical, haemorrhagical, inflammatory and traumatological causes act but do not enable the stability of the abdominal content, abdominal compliance and parietal tension. The initial triad of effects consists in diaphragm elevation and visceral and vascular compression and therefore triggers a physio-pathological way that leads to a respiratory, renal and cardiovascular dysfunction and to parietal, hepatic and intestinal ischaemia and consequent bacterial translocation: sepsis and MOF. Burch's classification (1996) reports four levels of gravity from low (<15 mmHg) to severe (>35 mmHg): both of the first grades should be managed in intensive-care units with conservative pharmacological procedures, while for the two others a surgical approach of laparotomy with drainage and temporaneous closure of the abdominal wall should be considered. As mortality is still very high (29-62%), especially when multiorgan failure is already set; bladder pressure of all critical patients should be monitorized to treat immediately any potential abdominal hypertension.

Abdomen↗
PubMed2006

Recognition and management of abdominal compartment syndrome in the United Kingdom.

OBJECTIVE: Abdominal compartment syndrome(ACS) is a condition associated with high mortality if undiagnosed and untreated. ACS is seen in patients managed in intensive care units. Very little is known on the causes, diagnosis and treatment of this condition in the United Kingdom. DESIGN: Questionnaire study. SETTINGS: 222 intensive care units in the UK dealing with acute abdominal condition. RESULTS: 127 (57.2%) questionnaires were returned (32 from teaching hospitals and 95 from district general hospitals. Among these, 96.9% of teaching hospitals and 72.6% of district general hospitals had seen cases of ACS. The conditions most frequently associated with ACS were small and large bowel surgery (67%), vascular surgery (62%) and trauma (60%). ACS was suspected mainly when there was a distended abdomen (98.6%), oliguria (94.5%) and increased ventilatory support (72.2%). The diagnosis was confirmed either clinically (68.4%) or by measuring intra-abdominal pressure (83.7%). The commonest method for measuring intra-abdominal pressure was the intra-vesical route. The pressure threshold for diagnosing the condition was variable, with a range of 11-50 mmHg. There was a large variation in the number of patients who were decompressed. CONCLUSION: Fewer patients are diagnosed with ACS in district general hospitals compared with teaching hospitals. The threshold for the diagnosis of ACS is variable in the UK, as were the numbers of patients who were decompressed, suggesting that many doctors are still reluctant to accept this condition. This study would suggest that there is a need for standardisation of diagnostic threshold and protocols regarding decompression in ACS.

Compartment Syndromes↗
PubMed1996

Unusual development of acute exertional compartment syndrome due to delayed diagnosis. A case report.

Our report describes the case of a 20 year old man who developed an acute exertional anterior tibial compartment syndrome after playing soccer for five minutes. No trauma was reported. Correct diagnosis was delayed for 18 hours, because pain was misinterpreted as resulting from acute muscular tetanic spasm induced by hyperventilation. Fasciotomy was contributed. After one year, the patient complained of early fatigue. Electromyographically the reinnervation had not yet been completed. This case illustrates the necessity for careful observation of non-trauma related acute tibial anterior pain appearing even at the beginning of strenuous exercise. It is important to recognize the possibility of a very acute onset of exertional compartment syndrome that does not subside with rest. Only early diagnosis and fasciotomy can prevent severe complications of an acute exertional compartment syndrome.

Acute Disease↗
PubMedDate not supplied

Compartment syndromes of the forearm: diagnosis and treatment.

Twenty-six patients with suspected forearm compartment syndromes were evaluated clinically and by intracompartmental pressure determinations. The most reliable physical findings indicating a forearm compartment syndrome were marked pain on passive digital extension and reduced hand sensibility or paresthesias. Pressure determinations were most helpful in evaluating comatose patients and patients with equivocal physical findings. A curvilinear volar incision and, when indicated, a straight dorsal incision provided adequate decompression in the ten operatively treated patients. Postfasciotomy pressure determinations were helpful in assessing the adequacy of volar and dorsal decompression.

Adult↗
PubMed2001

Reperfusion and compartment syndromes: strategies for prevention and treatment.

Reperfusion syndrome refers to the damage done by restoration of blood flow to ischemic tissues and is distinct from the original ischemic insult itself, whereas compartment syndrome refers to the damage resulting from increased pressure within an enclosed fascial compartment that occurs after blood flow has been restored. Despite extensive experimental work directed toward the treatment of established reperfusion injury and prevention of compartment syndrome, clinical outcome over the past decade has not appreciably changed. Although the systemic insult, thought to be an inevitable result of reperfusion injury, may be less injurious than "conventional wisdom" would suggest, no better strategy for treating compartment syndrome other than early recognition and decompression has yet been developed.

Compartment Syndromes↗
PubMed1979

Compartment syndrome of the interosseous muscles: early recognition and treatment.

A compartment syndrome of the interosseous muscles can be a challenging diagnosis as there is generally no neurovascular compromise to the digits involved. The most sensitive clinical sign is pain with passive motion at the metacarpal phalangeal joint of the involved digit. In this report, a 31-year-old man developed a compartment syndrome of the first, second, and third dorsal interosseous muscles following an injection of heroin in the "snuffbox" area. Compartmental tissue pressure measurements were 80, 75, and 55 mmHg respectively, and were a significant aid in the early diagnosis as well as management.

Adult↗
PubMed1987

Superficial posterior compartment syndrome of the leg with deep venous compromise. A case report.

A 15-year-old boy was struck twice in the calf, developing what appeared initially to be phlebitis and deep venous compromise. Careful clinical examination and compartment pressure measurement revealed the presence of an isolated superficial posterior compartment syndrome. Fasciotomy provided prompt relief. Findings at surgery showed ischemic changes but no necrosis. Venous patency was demonstrated on a subsequent venogram. Recovery was complete. This is the first reported case of isolated traumatic superficial posterior compartment syndrome. It adds to numerous other reports and provides further evidence that compartment syndrome can occur in any myofascial compartment. The concurrent deep venous compromise, although physiologically expected because of pressure differentials, was graphically demonstrated for the first time as well. Its clinical significance is not clear.

Adolescent↗
PubMed1996

Compartment syndrome as a complication of the prolonged use of the Lloyd-Davies position.

Compartment syndrome in the legs is a rare complication of the prolonged use of the lithotomy position. We report two cases of compartment syndrome developing as a complication of the prolonged use of the Lloyd-Davies position. Both patients received combined general and epidural anaesthesia and postoperative epidural analgesia. The diagnosis was delayed in the first case, resulting in the avoidable complications of renal failure and permanent neuromuscular dysfunction.

Adult↗
PubMed2004

Brain death due to abdominal compartment syndrome caused by massive venous bleeding in a patient with a stable pelvic fracture: report of a case.

We report a rare case in which abdominal compartment syndrome resulting from venous hemorrhaging developed in a patient with stable pelvic fractures, resulting in a fatal outcome. An 84-year-old man with mild pelvic fractures developed hypovolemic shock and underwent transcatheter arterial embolization. He became hemodynamically stable after the procedure, but became hypotensive for the second time 11 h after admission. Urinary bladder pressure rose to 32 mmHg from 4-7 mmHg. Rebleeding from the pelvis with the development of abdominal compartment syndrome was suspected. Repeated transcatheter arterial embolization and laparotomy were performed; however, 1 min into the procedure, both pupils symmetrically dilated and the light reflex disappeared. This case suggests that brain death can sometimes occur due to abdominal compartment syndrome.

Accidental Falls↗
PubMed1998

Causes of upper extremity compartment syndrome.

Multiple causes, including various types of trauma, prolonged compression, muscle avulsions, burn, snake bites, high-pressure injection injuries, exercise, infection, bleeding, and intravenous drug infiltration, have been reported to lead to the development of a compartment syndrome in the upper extremity. Awareness of the different causes and risks of compartment syndrome should facilitate early diagnosis and prompt treatment to help avoid the development of serious sequelae such as Volkmann's ischemic contracture. A review of the various reports of upper extremity compartment syndromes and classification systems is presented to assist in the understanding of this condition's development.

Arm↗
PubMed1998

Lower extremity compartment syndrome resulting from a toddler's bed.

This report recounts an unusual case of compartment syndrome of the leg and foot resulting from hanging on the side of a toddler's bed in a 11/2-year-old boy. Parents apparently found the patient on the side of the bed in the morning. Presentation to hospital revealed obvious tense compartments of the leg and foot. Intraoperative pressures were >100 mm Hg. Complete fasciotomies with secondary closure and skin grafting were performed. An ankle-foot orthrosis was used to prevent progression of ankle equinus. Jobst pressure garments were used to prevent hypertrophic scarring. One-year follow-up showed normal gait, function, and joint range of motion. Social services were consulted and the US Consumer Product Safety Commission was notified. As pediatric physicians, we need to be aware of possible and potential hazards in the child's environment. This case represents a unique case of compartment syndrome related to persistent limb elevation and compression.

Beds↗
PubMed1994

Anatomic bases of the forearm compartment syndrome.

One of the most common sites for the compartment syndrome (CS) is the forearm. Its compartments have been studied by injection of colored gelatin into the particular anatomical spaces. The three "pressure-measuring-points" recommended in the clinical literature to measure intracompartmental tissue pressure in equivocal diagnostic cases were used for the dye injections on the forearms of five preserved cadavers of adults. However, instead of the compartments especially affected in CS two adjacent spaces were revealed. In order to elucidate the clinical relevant spaces two additional approaches for the injection had been used. Cross-sections at 15 mm intervals of the injected forearms had been performed. Some of them are presented and schematically summarized in this article. Recent studies have suggested that there are different guidelines for description of the anatomically isolated spaces. However, especially one of these spaces seems to be responsible for the CS on the forearm. The remarkable features of this so called "deep flexor compartment" are its very restrictive envelopes, its rare fascial contacts, its impermeable seal in proximal-radial direction as well as the extremely endangered structures within the compartment. The flexor carpi ulnaris muscle is recommended to be the "primary structure" for measuring the tissue pressure as well as for surgical decompression. The article reviews the anatomical base of the CS.

Adult↗
PubMed1990

Inhibition of the compartment syndrome by the ablation of free radical-mediated reperfusion injury.

Skeletal muscle edema secondary to an increase in capillary permeability after reflow is an important cause of the compartment syndrome after acute arterial revascularization. The purpose of this study was to investigate the possible role of oxygen free radicals, generated at reperfusion, in the pathogenesis of the compartment syndrome secondary to acute arterial ischemia/reperfusion. A reproducible model of this syndrome was produced in anesthetized rabbits by femoral artery occlusion after surgical devascularization of collateral branches from the aorta to the popliteal artery. Increasing periods of ischemia from 6 to 12 hours, followed by 2 hours of reperfusion, were associated with corresponding increases in the anterior muscle compartment hydrostatic pressure and inversely proportional decreases in tibialis anterior muscle blood flow within that compartment as assessed by xenon 133 washout (n = 46) (r = -0.62, p less than 0.001). Anterior compartment pressure increased from 5 +/- 1 to 48 +/- 5 mm Hg (n = 46) (p less than 0.001) after 7 hours of total arterial ischemia and 2 hours of reperfusion. Ablation of free radicals generated from xanthine oxidase with either allopurinol (n = 8) or oxypurinol (n = 8), by scavenging the superoxide radical at reperfusion with superoxide dismutase (n = 8), or by blocking secondary hydroxyl radical formation with deferoxamine (n = 8) significantly ameliorated the rise in compartment pressure (p less than 0.05) in each case; it also significantly improved muscle perfusion in the superoxide dismutase-, allopurinol-, and deferoxamine-treated animals (p less than 0.05). These findings indicate that development of the compartment syndrome after acute arterial revascularization may be due, at least in part, to microvascular injury mediated by oxygen-derived free radicals generated from xanthine oxidase at reperfusion.

Allopurinol↗
PubMedDate not supplied

Compartment syndrome, rhabdomyolysis and risk of acute renal failure as complications of the lithotomy position.

Compartment syndrome, rhabdomyolysis and the risk of acute renal failure are potential complications of the lithotomy position. A six-year-old girl is described who developed a compartment syndrome with rhabdomyolysis after prolonged surgery in the lithotomy position. This complication occurred three times over ten years in our hospital. Rhabdomyolysis may induce acute renal failure. The pathogenesis of rhabdomyolysis--induced renal failure has not yet been elucidated. However, forced diuresis by intravenous administration of mannitol and furosemide can prevent acute renal failure.

Acute Kidney Injury↗
PubMed1999

Abdominal compartment syndrome: does intra-cystic pressure reflect actual intra-abdominal pressure? A prospective study in surgical patients.

BACKGROUND: Abdominal compartment syndrome is defined as the adverse physiologic effects of increased intra-abdominal pressure. Prolonged, unrelieved pressure may lead to respiratory compromise, renal impairment, cardiac failure, shock, and death. Abdominal compartment syndrome is diagnosed by measuring intra-cystic pressure as a reflection of intra-abdominal pressure. To examine the validity of the technique, we conducted a prospective study in surgical patients by directly measuring bladder and abdominal pressures simultaneously during laparoscopic cholecystectomy using a previously described technique. RESULTS: In the present model, the bladder had higher baseline pressures than did the abdomen. Measurements across the bladder wall were not identical, but had high positive correlation coefficient when evaluated on an individual basis. Global analysis of the data for all patients showed a weak correlation coefficient. CONCLUSION: In the present study model, intra-cystic pressure did not reflect actual intra-abdominal pressure. In spite of some limitations in the study design, we feel that further research is warranted to identify other possible variables that may play a role in the relationship between the urinary bladder and the abdominal cavity pressures, providing better means for diagnosis of abdominal compartment syndrome.

Journal Article↗
PubMed1987

Compartment syndrome delays tibial union.

There has been no previous investigation into the association between compartment syndrome and delayed or nonunion of the tibia following fracture. To establish whether such an association might exist, a retrospective survey of the results of the treatment of closed and Grade I tibial fractures complicated by compartment syndrome was undertaken. The survey showed that there was a significant delay in fracture union in patients over 18 years of age, but not in younger patients.

Adolescent↗