ABSTRACT
Presented in this paper is our experience in the diagnosis and management of abdominal compartment syndrome during severe acute pancreatitis. On the basis of the history of severe acute pancreatitis, after effective fluid resuscitation, if patients developed renal, pulmonary and cardiac insufficiency after abdominal expansion and abdominal wall tension, ACS should be considered. Cystometry could be performed to confirm the diagnosis. Emergency decompressive celiotomy and temporary abdominal closure with a 3 liter sterile plastic bag must be performed. It is also critical to prevent reperfusion syndrome. In 23 cases of ACS, 18 cases received emergency decompressive celiotomy and 5 cases did not. In the former, 3 patients died (16.7%) while in the later, 4 (80%) died. Total mortality rate was 33.3% (7/21). In 7 death cases, 4 patients developed acute obstructive suppurative cholangitis (AOSC). All the patients who received emergency decompressive celiotomy 5 h after confirmation of ACS survived. The definitive abdominal closure took place mostly 3 to 5 days after emergency decompressive celiotomy, with longest time being 8 days. 6 cases of ACS at infection stage were all attributed to infected necrosis in abdominal cavity and retroperitoneum. ACS could occur in SIRS stage and infection stage during SAP, and has different pathophysiological basis. Early diagnosis, emergency decompressive celiotomy and temporary abdominal closure with a 3L sterile plastic bag are the keys to the management of the condition.
Subject(s)
Abdomen , Compartment Syndromes/diagnosis , Compartment Syndromes/etiology , Compartment Syndromes/surgery , Decompression, Surgical , Multiple Organ Failure/diagnosis , Multiple Organ Failure/etiology , Multiple Organ Failure/surgery , Pancreatitis, Acute Necrotizing/complications , Pancreatitis, Acute Necrotizing/diagnosis , Pancreatitis, Acute Necrotizing/surgeryABSTRACT
Se mencionan las condiciones clínicas, hemodinámicas y metabólicas que condicionan el Síndrome de Falla Orgánica Múltiple (FOM) y se analizan los factores de riesgo que influyen en su desarrollo, haciendo énfasis en su prevención orientado al buen manejo hemodinámico, nutricional, ventilatorio y de la sepsis que habitualmente acompaña este cuadro
Subject(s)
Humans , Preoperative Care , Multiple Organ Failure/surgery , Multiple Organ Failure/diagnosis , Multiple Organ Failure/physiopathologyABSTRACT
Se estudian retrospectivamente 46 pacientes con FMO tratados en la UCI del Hospital Dr. Sótero del Río, entre enero de 1983 y diciembre de 1984. Se analiza la asociación de sistemas comprometidos, su frecuencia y letalidad. En el grupo quirúrgico (50% de la serie), la mortalidad se asocia directamente a : error clínico quirúrgico, injuria metabólica y sepsis. La mortalidad de la serie es de 78,3%. Planteamos la existencia de dos formas de FMO, una precoz después de la injuria y otra tardía; la primera de menor letalidad