• VAC therapy
• abdominal compartment syndrome
• abdominal surgery
• open abdominal cavity
• peritonitis

• Humans
• Middle Aged
• Intra-Abdominal Hypertension/etiology
• Intra-Abdominal Hypertension/diagnosis
• Intra-Abdominal Hypertension/surgery
• Negative-Pressure Wound Therapy/methods
• Peritonitis/etiology
• Peritonitis/surgery
• Peritonitis/diagnosis
• Severity of Illness Index
• Treatment Outcome

• abdominal sepsis
• fistula
• intestinal failure

Background  Acute pancreatitis is a significant challenge to health services. Remarkable progress has been made in the last decade in optimizing its management.

Methods  This review is a comprehensive assessment of 7 guidelines employed in current clinical practice with an appraisal of the underlying evidence, including 15 meta-analyses/systematic reviews, 16 randomized controlled trials, and 31 cohort studies.

Results  Key tenets of early management of acute pancreatitis include severity stratification based on the degree of organ failure and early goal-directed fluid resuscitation. Rigorous determination of etiology reduces the risk of recurrence. Early enteral nutrition and consideration of epidural analgesia have been pioneered in recent years with promising results. Indications for invasive intervention are becoming increasingly refined. The definitive indications for endoscopic retrograde cholangiopancreatography in acute pancreatitis are associated with cholangitis and common bile duct obstruction. The role of open surgical necrosectomy has diminished with the development of a minimally invasive step-up necrosectomy protocol. Increasing use of endoscopic ultrasound–guided intervention in the management of pancreatic necrosis has helped reduce pancreatic fistula rates and hospital stay.

Conclusion  The optimal approach to surgical management of complicated pancreatitis depends on patient physiology and disease anatomy, in addition to the available resources and expertise. This is best achieved with a multidisciplinary approach. This review provides a distillation of the recommendations of clinical guidelines and critical discussion of the evidence that informs them and presents an algorithmic approach to key areas of patient management.

• acute pancreatitis
• necrotizing pancreatitis
• pseudocyst
• biliary pancreatitis

• intra-abdominal pressure
• mechanical ventilation
• prediction tool
• pulmonary compliance

Intestinal obstruction is associated with significant morbidity and mortality. Scientific assessment of the cause, site of obstruction, appropriate correction of the fluid deficit and electrolyte imbalance with preoperative stabilization of blood gases is ideal as a preoperative workup. Placement of a preoperative epidural catheter especially in the thoracic interspace takes care of perioperative pain and stress reduction. Intraoperative management by controlled general anesthesia administering a relative high inspired fraction of oxygen with invasive monitoring in selected sick cases is mandatory. Preoperative monitoring and stabilizing raised intra-abdominal pressure reduces morbidity. Caution should be exercised during opening and closure of abdomen to avoid cardiorespiratory ill effects. There should be an emphasis on avoiding hypothermia. The use of nonsteroidal anti-inflammatory drugs may worsen sick, fragile patients. The use of sugammadex rather than neostigmine will obscure certain controversies in the healing of intestinal anastomotic site. Replacement of blood loss continued correction of fluids and electrolytes with possible postoperative mechanical ventilation in sick cases may improve outcomes in these patients.

• Anesthesia
• intestinal obstruction
• outcome

Intra-abdominal hypertension (IAH) is defined as a sustained elevation in intra-abdominal pressure (IAP) greater than or equal to 12 mmHg. IAH has been shown to cause organ derangements and dysfunction in the body. Objective screening of IAH is neither done early enough nor at all thus leading to significant morbidity and mortality among surgical patients. The epidemiology and outcome of IAH among surgical patients has not been documented in Uganda. The aim of this study was to determine the prevalence, incidence and outcome of intra-abdominal hypertension among patients undergoing emergency laparotomy.

Prospective observational study, conducted from January to April 2015 among patients undergoing emergency laparotomy. Inclusion criteria was; age >7 yrs, scheduled for emergency laparotomy, able to lie supine. Exclusion Criteria: pregnant, failed urethral catheterization, known cardiac, renal and respiratory disorders. Consecutive sampling was used. IAP, blood pressure, heart rate, respiratory rate, Sp02, Serum creatinine, Serum urea, and Urine output were measured preoperatively and postoperatively at 0, 6, 24 and 48 h. IAH was defined as IAP > 12 mmHg on three consecutive readings 3 min apart.

In total 192 patients were enrolled. Mean age ± SD was 14.25 (±3.16) yrs in the paediatrics and 34.4(±13.72) yrs in the adults with male preponderance 65 and 80.7 % respectively. The prevalence of IAH was 25 % paediatrics and 17.4 % adults and the cumulative incidence after surgery was 20 % paediatrics and 21 % adults. In paediatrics, IAH was associated with mortality at 0 h postoperatively, RRR = 1:24, 95 % CI (1.371–560.178), p-value 0.048. In adults, the statistically significant outcomes associated with IAH were respiratory system dysfunction RRR1:2.783, p-value 0.023, 95 % CI (1.148–6.744) preoperatively and mortality RRR 1:2.933, p-value 0.034, 95 % CI (1.017–8.464) at 6 h, RRR 1:3.769, p-value 0.033, 95 % CI (1.113–12.760) at 24 h postoperatively.

The prevalence and incidence of IAH in the paediatrics and adults group in our study population were high. IAH was associated with mortality in both adult and paediatrics groups and respiratory system dysfunction in adult group. This calls for objective monitoring of intraabdominal pressure in patients undergoing emergency laparotomy with the aim of reducing associated mortality.

• Emergency laparotomy
• Intra-abdominal hypertension
• Intra-abdominal pressure
• Mortality

• Compartment syndrome
• Emergency
• Hyperthermic intraperitoneal chemotherapy
• Pseudomyxoma
• Surgery

•

Venous catheter malposition is a rare event with potential catastrophic consequences.

Venous catheter malposition is a rare event with potential catastrophic consequences. To our knowledge we describe one of the first case reports of an adult presenting with a rare late complication of femoral venous catheter malposition: abdominal compartment syndrome.

A 39 year-old female sustained severe cerebral injury in a road traffic accident. During initial resuscitation a femoral venous catheter was inserted without ultrasound guidance with no immediate concerns. After 48 h whilst in intensive care unit the patient developed progressive abdominal distension. Bedside investigations revealed raised intra-abdominal pressures associated with new organ failure. Subsequent an emergency laparotomy and on-table intravenous contrast radiographs revealed extravasation of contrast into the peritoneal space from the malposition of the catheter into the abdominal cavity.

Complications of central venous catheterization are associated with adverse events with significant morbidity to the patient as well as having cost implications. Mechanical complications are underreported but are potentially preventable through ultrasound-guided insertion, in accordance with international guidelines.

This case report highlights the importance of safe methods of catheter insertion, the need for increased awareness of late femoral catheter malposition and its potential catastrophic consequences.

• Abdominal compartment syndrome
• Femoral vein catheter
• Malposition of central venous catheter

• Abdominal compartment syndrome
• Intra-abdominal hypertension
• Intra-abdominal pressure
• Laparotomy
• Trauma

• Abdominal Injuries/complications
• Abdominal Injuries/diagnosis
• Adult
• Australia
• Crystalloid Solutions
• Female
• Humans
• Incidence
• Intra-Abdominal Hypertension/diagnosis
• Intra-Abdominal Hypertension/etiology
• Intra-Abdominal Hypertension/prevention & control
• Isotonic Solutions/therapeutic use
• Laparotomy/adverse effects
• Male
• Middle Aged
• Resuscitation/methods
• Retrospective Studies
• Trauma Centers/statistics & numerical data
• Treatment Outcome

Acute pancreatitis (AP) is an inflammatory disease of the pancreas which involves the pancreas and surrounding tissue, and systemic inflammation with a characteristic systemic increase of vascular permeability and increased risk of multiple organ dysfunction. Currently, the pathogenesis of AP is fuzzy, and the diagnosis and treatment need to be standardized. Nevertheless, increased knowledge of AP may achieve more thorough understanding of the pathogenesis. The use of further advanced diagnostic tools and superior treatment, potentially will help clinicians to manage AP at an appropriate stage. However, in view of the multi factorial disease and the complex clinical manifestations, the management of patients with AP is also remaining areas for improvement.

• Acute pancreatitis
• Organ failure
• Necrosis
• Inflammation
• Management

• Acute Disease
• Animals
• Disease Progression
• Humans
• Pancreatitis/diagnosis
• Pancreatitis/etiology
• Pancreatitis/mortality
• Pancreatitis/physiopathology
• Pancreatitis/therapy
• Predictive Value of Tests
• Treatment Outcome

• non-operative management of liver trauma
• blunt liver injuries
• damage control
• perihepatic packing
• abdominal compartment syndrome

• Adolescent
• Adult
• Child
• Clinical Protocols
• Female
• Humans
• Kuwait
• Liver/injuries
• Male
• Middle Aged
• Practice Guidelines as Topic
• Prospective Studies
• Registries
• Retrospective Studies
• Trauma Severity Indices
• Wounds, Nonpenetrating/surgery
• Wounds, Nonpenetrating/therapy
• Young Adult

• Abdomen/surgery
• Abdominal Wound Closure Techniques
• Adult
• Aged
• Aged, 80 and over
• Female
• Humans
• Male
• Middle Aged
• Negative-Pressure Wound Therapy
• Retrospective Studies

Liver transplant for trauma is a rare condition with 19 cases described in the literature. We report the case of a 16-year-old patient who suffered a gradeV liver injury with a vena cava tear after a car crash. After a computerized tomography (CT) scan, the patient was directly sent to the operating room where the surgeon performed a right hepatectomy extended to segment IV with a venous repair under discontinued hilar clamping. On day five, the patient developed acute liver failure and was put on an emergency transplant waiting list. He had a successful liver transplant 2 days later. Fifteen months after his transplant, the patient is alive and asymptomatic. This case report focuses on the patient’s initial management, the importance of damage control surgery and the circumstances which finally led to the transplant.

• Liver trauma
• damage control surgery
• transplantation

• spontaneous retroperitoneal hematoma
• abdominal compartment syndrome
• femoral neuropathy
• anticoagulation

• Abdomen
• Anticoagulants/adverse effects
• Compartment Syndromes/etiology
• Female
• Gastrointestinal Hemorrhage/chemically induced
• Gastrointestinal Hemorrhage/congenital
• Hematoma/etiology
• Hematoma/surgery
• Humans
• Iliac Artery/diagnostic imaging
• Iliac Artery/pathology
• Middle Aged
• Tomography, X-Ray Computed

• Abdominal Cavity
• Abdominal Wound Closure Techniques
• Adult
• Aged
• Cohort Studies
• Compartment Syndromes/mortality
• Compartment Syndromes/surgery
• Critical Care
• Decompression, Surgical
• Female
• Humans
• Lower Body Negative Pressure
• Male
• Middle Aged
• Retrospective Studies
• Treatment Outcome
• Young Adult

• ovarian hyperstimulation syndrome (ohss)
• abdominal compartment syndrome (acs)
• intraabdominal pressure (iap)
• intraabdominal hypertension (iah)
• paracentesis

• Abdomen/blood supply
• Abdomen/physiopathology
• Algorithms
• Compartment Syndromes/classification
• Compartment Syndromes/diagnosis
• Compartment Syndromes/etiology
• Compartment Syndromes/physiopathology
• Diagnosis, Differential
• Female
• Hemodynamics/physiology
• Humans
• Hypertension/complications
• Ovarian Hyperstimulation Syndrome/diagnosis
• Ovarian Hyperstimulation Syndrome/etiology
• Ovarian Hyperstimulation Syndrome/physiopathology
• Ovarian Hyperstimulation Syndrome/therapy
• Paracentesis/methods

• ZIA HD008737 Intramural NIH HHS
• ZIA HD008737-09 Intramural NIH HHS

• Abdomen/physiology
• Animals
• Continuous Positive Airway Pressure/methods
• Hemodynamics
• Hypertension
• Male
• Pulmonary Gas Exchange
• Respiration, Artificial
• Respiratory Mechanics/physiology
• Swine
• Ventilator-Induced Lung Injury
• Work of Breathing/physiology

• Emergency Service, Hospital
• Humans
• Perioperative Care
• Surgical Procedures, Operative

AIM: To assess the use of topical negative pressure (TNP) in the management of severe peritonitis.

METHODS: This is a four-year prospective analysis from January 2005 to December 2008 of 20 patients requiring TNP following laparotomy for severe peritonitis.

RESULTS: There were 11 males with an average age of (59.3 ± 3.95) years. Nine had a perforated viscus, five had anastomotic leaks, three had iatrogenic bowel injury, and a further three had severe pelvic inflammatory disease. TNP and the VAC^® Abdominal Dressing System were initially used. These were changed every two to three days. Abdominal closure was achieved in 15/20 patients within 4.53 ± 1.64 d. One patient required relaparotomy due to residual sepsis. Two patients with severe faecal peritonitis due to perforated diverticular disease received primary anastomosis at second look laparotomy, as sepsis and their general condition improved. In the remaining 5/20 cases, the abdomen was left open due to bowel oedema and or abdominal wall oedema. Dressing was switched to TNP and VAC^® GranuFoam^®. Three of the five patients returned a few months later for abdominal wall reconstruction and restoration of intestinal continuity. Two patients developed intestinal fistulae. All 20 patients survived.

CONCLUSION: The use of TNP is safe. Further studies are needed to assess its value in managing these difficult cases.

• Severe peritonitis
• Open abdomen
• Topical negative pressure
• VAC® Abdominal Dressing System
• VAC® GranuFoam®

AIM: To investigate the therapeutic effect of traditional Chinese traditional medicines Da Cheng Qi Decoction (Timely-Purging and Yin-Preserving Decoction) and Glauber’s salt combined with conservative measures on abdominal compartment syndrome (ACS) in severe acute pancreatitis (SAP) patients.

METHODS: Eighty consecutive SAP patients, admitted for routine non-operative conservative treatment, were randomly divided into study group and control group (40 patients in each group). Patients in the study group received Da Cheng Qi Decoction enema for 2 h and external use of Glauber’s salt, once a day for 7 d. Patients in the control group received normal saline (NS) enema. Routine non-operative conservative treatments included non-per os nutrition (NPON), gastrointestinal decompression, life support, total parenteral nutrition (TPN), continuous peripancreatic vascular pharmaceutical infusion and drug therapy. Intra-cystic pressure (ICP) of the two groups was measured during treatment. The effectiveness and outcomes of treatment were observed and APACHE II scores were applied in analysis.

RESULTS: On days 4 and 5 of treatment, the ICP was lower in the study group than in the control group (P < 0.05). On days 3-5 of treatment, acute physiology and chronic health evaluation II (APACHE II) scores for the study and control groups were significantly different (P < 0.05). Both the effectiveness and outcome of the treatment with Da Cheng Qi Decoction on abdominalgia, burbulence relief time, ascites quantity, cyst formation rate and hospitalization time were quite different between the two groups (P < 0.05). The mortality rate for the two groups had no significant difference.

CONCLUSION: Da Cheng Qi Decoction enema and external use of Glauber’s salt combined with routine non-operative conservative treatment can decrease the intra-abdominal pressure (IAP) of SAP patients and have preventive and therapeutic effects on abdominal compartment syndrome of SAP.

• Da Cheng Qi Decoction
• Glauber’s salt
• Traditional Chinese medicine
• Severe acute pancreatitis
• Abdominal compartment syndrome

• Abdominal Injuries/surgery
• Adult
• Aged
• Decompression, Surgical
• Female
• Follow-Up Studies
• Hemodynamics
• Humans
• Hypertension/physiopathology
• Hypertension/surgery
• Male
• Middle Aged
• Peritonitis/surgery
• Prospective Studies

• Anticoagulants/adverse effects
• Compartment Syndromes/etiology
• Female
• Gastrointestinal Hemorrhage/chemically induced
• Gastrointestinal Hemorrhage/complications
• Hematoma/chemically induced
• Humans
• Middle Aged
• Retroperitoneal Space
• Warfarin/adverse effects

• Abdomen
• Abdominal Cavity
• Adult
• Aged
• Aged, 80 and over
• Compartment Syndromes/surgery
• Female
• Humans
• Male
• Middle Aged
• Occlusive Dressings
• Peritonitis/surgery
• Prospective Studies
• Sepsis/surgery
• Vacuum