Abdominal compartment syndrome

ACS is fatal if left untreated. Even with treatment, the mortality is high. Patients who are at risk for development of ACS remain at increased risk throughout their ICU stay and even after discharge. Furthermore, patients who have undergone decompressive laparotomy may develop recurrent ACS, particularly if inciting events have not been addressed, if temporary dressings are too tight or because of progression of underlying disease states.

Response to treatment

The usual response to definitive surgical treatment is an immediate decrease in intra-abdominal pressure and concomitant improvement in organ dysfunction, haemodynamics, and acid-base derangements. Frequently, especially if treatment is instituted early, urine volumes will increase, oxygenation will improve, mean arterial pressure will rise, and patients will have a decreased need for inotropic or pressor agents.

Repeat laparotomy

Some patients may need to undergo a repeat laparotomy to inspect the viability of the viscera, especially if ACS was diagnosed late, to remove persistent blood or fluid collections, and possibly to begin to re-approximate the fascia. Worsening of acidosis or clinical course in this setting mandates re-exploration, because bowel infarction or perforation from ACS may be present.