Abstract
Normal intra-abdominal pressure (IAP), usually measured indirectly as intra-bladder pressure, is in the range of 5-7 mmHg. Sustained high IAP (≥12 mmHg) is termed intra-abdominal hypertension (IAH), and the abdominal compartment syndrome (ACS) is defined as sustained IAH (>20 mmHg) complicated by novel organ failure or dysfunction. ACS is categorized according to the cause into three types; primary, secondary, and recurrent ACS. Primary ACS is of abdominal origin, such as that caused by blunt abdominal trauma and acute pancreatitis. Secondary ACS is of extra-abdominal origin, such as that caused by severe burns, multiple trauma requiring massive fluid and blood administration, etc. Recurrent ACS occurs following closure of the distended abdomen due to primary or secondary ACS. A stepwise approach has been suggested for the management of ACS; 1) emptying of the gastrointestinal tract, 2) drainage of intra-abdominal fluids, 3) improvement of the abdominal wall compliance, 4) optimization of fluid administration, and 5) adjustment of local and systemic tissue perfusion. For refractory ACS, aggressive open abdominal management is warranted. Recently, damage control resuscitation, or restrictive fluid management to avoid ACS has been recommended, especially for cases of ACS complicating abdominal trauma. Novel closure methods for open abdomen have also been proposed to avoid recurrent ACS.
