Abstract
Objectives & Methods: The presence of massive intestinal edema or a large intra-abdominal hematoma after repair of a ruptured abdominal aortic aneurysm (r-AAA) may cause an increase in intra-abdominal pressure following primary abdominal wall closure, resulting in the development of abdominal compartment syndrome (ACS) which is a fatal complication of r-AAA repair. When primary closure of the abdominal wall was not possible because of severe intestinal edema, we performed temporary abdominal closure using a vinyl sheet made from an intravenous feeding pack to prevent ACS. Relaparotomy was performed to release intra-abdominal pressure in the event of ACS developing after primary abdominal wall closure.
Results: We reviewed 36 patients who underwent r-AAA repair between January 2006 and December 2008 (including 2 patients with ruptured iliac artery aneurysms). Seven patients underwent temporary abdominal closure after r-AAA repair of whom 2 died of disseminated intravascular coagulation (DIC) and 1 died of intestinal necrosis, but these complications appeared unrelated to ACS. There were 4 patients who underwent abdominal closure without developing ACS and were discharged. Twenty-nine patients underwent primary abdominal closure after r-AAA repair and 26 of these did not require relaparotomy. Two patients died of multiple organ failure and 1 died of DIC, but these complications were unrelated to ACS. Three of the twenty-nine patients suffered ACS after primary abdominal closure and underwent relaparotomy. All patients were able to undergo abdominal closure without developing ACS. Two patients were discharged but one patient died of graft infection. Multivariate logistic analysis indicated that preoperative shock (systolic blood pressure<90 mmHg) (odds ratio (OR) 11.02, 95% confidence interval (CI) 1.14–106.6, p=0.04) serum creatinine (Cr) >2.0 mg/dl (OR 9.74, 95% CI 1.08–88.1, p=0.04) and base excess<–13 (OR 6.82, 95% CI 1.00–46.4, p=0.05) were risk factors associated with temporary abdominal closure.
Conclusion: Patients with these risk factors are likely to require temporary abdominal closure and need careful postoperative monitoring of their intra-abdominal pressure.
