Treatment of intraabdominal hypertension in patients with acute pancreatitis

Abstract

Intra-abdominal hypertension is a serious problem in acute surgical pathology, especially in acute pancreatitis, which is dangerous for the development of abdominal compartment syndrome [1, 2]. Prolonged significant increase in intra-abdominal pressure leads to severe disorders of organs and systems of the body (mostly ischemic and respiratory), which cause multiple organ failure syndrome. When the latter mortality reaches 42-68% [3]. The purpose of the study is to improve the algorithm of conservative methods of intra-abdominal hypertension correction. Materials and methods of research. Intra-abdominal hypertension of various degree was found at 35 patients with acute pancreatitis at hospitalization by monitoring of intra-abdominal pressure in a bladder. Grade I intra-abdominal hypertension was detected in 12 patients (34,3%), II - in 18 (51,4%), III - in 5 (14,3%). According to the protocols, conservative treatment was performed in 15 patients (42,9%) (group 1). In order to control intra-abdominal hypertension 20 patients (57,1%) were additionally prescribed antiflatulants in a tube for enteral nutrition (group 2). Results of the research. In patients of group 1, normalization of intestinal function (reduction of bloating, flatulence, independent stool) was achieved within a week in 60% of patients, in group 2 - in 90%. When monitoring intra-abdominal pressure in a bladder in patients of group 1, a significant reduction in intra-abdominal pressure was achieved in 8 people (53,3%): in 5 of 7 patients (71,4%) with baseline intra-abdominal hypertension I degree, in 2 of 6 (33,3%) - II degree and one of the two (50%) - III degree. In patients of group 2 normalization of intra-abdominal pressure was achieved in 17 people (85%): in all 6 patients with intra-abdominal hypertension I degree, in 9 out of 11 (81,8%) - II degree and in 2 out of 3 (66,7%) - III degree (p<0,05). Decompression laparotomy was performed in 2 patients of both groups with grade III intra-abdominal hypertension, in the absence of the effect of conservative measures to normalize intra-abdominal pressure. Conclusion. The use of antiflatunts in the complex treatment of intra-abdominal hypertension in patients with acute pancreatitis effectively normalizes intestinal function, thereby improving intra-abdominal pressure in the vast majority of patients and prevents the occurrence of abdominal compartment syndrome. References: 1. Goodchild G, Chouhan M, Johnson GJ. Practical guide to the management of acute pancreatitis. Frontline Gastroenterol. 2019 Jul;10(3):292-299. doi: 10.1136/flgastro-2018-101102. 2. Lee PJ, Papachristou GI. Management of Severe Acute Pancreatitis. Curr Treat Options Gastroenterol. 2020 Nov 19:1-12. doi: 10.1007/s11938-020-00322-x. 3. Marcos-Neira P, Zubia-Olaskoaga F, López-Cuenca S, Bordejé-Laguna L; Epidemiology of Acute Pancreatitis in Intensive Care Medicine study group. Relationship between intra-abdominal hypertension, outcome and the revised Atlanta and determinant-based classifications in acute pancreatitis. BJS Open. 2018 Mar 15;1(6):175-181. doi: 10.1002/bjs5.29.