Complications
The kidneys are particularly vulnerable to ischaemic injury; often some degree of renal dysfunction (elevated urea/creatinine).
Exacerbation of renal dysfunction complicates management of fluid overload.
Generally reversible and self-limiting, but more severe cases may require dialysis until renal function recovers.
Can be a differential diagnosis as well as a complication; in this situation, intra-abdominal pressure (IAP) is normal.
The kidneys are particularly vulnerable to ischaemic injury, which can lead to acute tubular necrosis.
Exacerbation of renal dysfunction complicates management of fluid overload.
Generally reversible and self-limiting, but patients with more severe cases may require dialysis until renal function recovers.
Can be a differential diagnosis as well as a complication; in this situation, IAP is normal.
Patients who have been treated for ACS may develop recurrent ACS. Best prevented by vigilant monitoring of IAP and early intervention if pressure increases or fails to decrease in response to definitive treatment.
If recurrent ACS develops in patients not initially treated with surgical decompression, then it must be undertaken. If patients develop recurrent ACS after decompressive laparotomy, dressings should be checked and patients may require re-operation, along with more aggressive adjunctive measures. Recurrent ACS causes increased morbidity as compared with isolated single episodes of ACS, an example of the so-called 'second hit' phenomenon.[53]
Elevations of IAP can produce ischaemic injury to the abdominal viscera. Small and large intestines are most frequently involved.
Physicians and surgeons should have a high index of suspicion for this complication if the IAP is very high, ACS is recognised late, or there is evidence of intestinal ischaemia at laparotomy or worsening sepsis, acidosis, or refractory shock.
Treatment involves surgical exploration and resection, repair, or diversion.
Elevation of IAP can produce perforation of the small and large intestine.
Physicians and surgeons should have a high index of suspicion for this complication if the IAP is very high, ACS is recognised late, or there is worsening sepsis, acidosis, or refractory shock.
Treatment involves surgical exploration and resection, repair, or diversion.
Many patients who require decompressive laparotomy develop a late ventral hernia requiring surgical correction.
If raised IAP can be reversed quickly, there is a window of approximately 7 to 10 days during which delayed fascial closure has a high success rate; if this window is missed, virtually all patients develop a hernia.
Patients who have undergone decompressive laparotomy are at risk for any of the complications that are attendant on any major abdominal operation, including adhesive bowel obstruction.
Patients who have undergone decompressive laparotomy are at risk for any of the complications that are attendant on any major abdominal operation, including adhesive bowel obstruction.
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