Significance of long-term monitoring of intra-abdominal pressure in case of acute pathology of the abdominal cavity organs

Abstract

Increased intra-abdominal pressure (IAP) in acute surgical pathology recurs in 70% of cases, which can be a dangerous development of systemic and local complications [1]. The most formidable complication of intra-abdominal hypertension (IAH) is abdominal cavity syndrome (ACS), which is accompanied by a mortality rate of 60-90% [2]. In this regard, constant diagnosis of possible changes in ICP indicators can timely inform the clinician about the development of possible complications in the abdominal cavity for adequate and immediate treatment [3]. The standard for determining THP is the measurement of bladder pressure (MBP)[4]. Objective: to improve the results of treatment of patients with IAH against the background of acute surgical pathology of the abdominal cavity. Methods. We used a developed method of long-term MBP using a two-balloon, three-lumen Foley catheter. The modified classification of Burch et al. was used to assess the degree of IAH. (1996) Measurements were carried out when the bladder was filled with 25 ml of saline. IAP parameters were recorded using an electronic strain gauge in mm Hg during the entire period of treatment of the patient. IAH correction was carried out according to our modified ICH control algorithm proposed by the World Society for the Study of Abdominal Compartment Syndrome (WSACS) in 2013. Results. As an example, we will cite one clinical case: patient M., 67 years old. She was admitted on 19.10.2022 at 12:32 to the Polytrauma Department of City Clinical Hospital No. 17 in Kyiv by emergency care with the diagnosis of "partial intestinal obstruction" during hospitalization. The patient complained of dull pain in the abdomen without a clear localization, nausea, poor passing of gases, absence of stool for 2 days. Suffers from a permanent form of atrial fibrillation. Pulse 76 per min., arrhythmic, blood pressure 130/80 mm Hg. The tongue is wet, coated with a whitish coating, the abdomen is moderately swollen, soft on palpation, moderately painful in the mesogastric area. Sklyarov's and Shotkin-Blumberg's signs are negative. X-ray and sonographic examination revealed no signs of acute intestinal obstruction. The patient underwent bladder catheterization with a Foley catheter, the initial IAP level was 12 mm Hg. Conservative measures were started for the patient: nasogastric decompression, intravenous therapy, siphon enema. After the treatment, the condition progressively improved. Control parameters of IAP during the first day of treatment were 11.2+0.4 mm Hg, during the second day – 10.5+0.2 mm Hg. However, on the third day of the patient's stay in the hospital, a rapid increase in IAP to 15.6 mm Hg was noted, while abdominal pain without a clear localization returned, and symptoms of peritoneal irritation appeared. Ultrasound revealed free fluid in the abdominal cavity, the absence of any peristalsis from the side of the small intestine. On October 22, 2022, the patient underwent surgery. During the operation, diffuse serous peritonitis was detected, the cause of which was necrosis of a section of the small intestine with a length of 1 m (60 cm proximal to the ileocecal junction) due to acute segmental arterial mesenteric thrombosis. The patient underwent resection of the necrotized part of the small intestine according to Kocher's rule, restoration of the integrity of the intestine by side-to-side anastomosis. In the postoperative period during the first day, IAP numbers were 16.1+0.6 mm Hg. with a gradual decrease in indicators according to the third day to 5.2+0.3 mm Hg. At the same time, recovery of intestinal peristalsis was clinically noted. The patient was discharged on October 29, 2022 (the 7th day of the postoperative period) in satisfactory condition. Control examination in 2 weeks - no complaints, condition is satisfactory. Conclusions. The use of long-term IAP monitoring has important diagnostic value not only for correcting the scheme of conservative treatment tactics, but also for timely detection of intra-abdominal complications that require urgent surgical intervention. Literature 1. Rogers WK, Garcia L. Intraabdominal Hypertension, Abdominal Compartment Syndrome, and the Open Abdomen. Chest. 2018 Jan;153(1):238-250. doi: 10.1016/j.chest.2017.07.023. Epub 2017 Aug 2. PMID: 28780148. 2. Sosa G, Gandham N, Landeras V, Calimag AP, Lerma E. Abdominal compartment syndrome. Dis Mon. 2019 Jan;65(1):5-19. doi: 10.1016/j.disamonth.2018.04.003. Epub 2018 Nov 17. PMID: 30454823. 3. De Laet IE, Malbrain MLNG, De Waele JJ. A Clinician's Guide to Management of Intra-abdominal Hypertension and Abdominal Compartment Syndrome in Critically Ill Patients. Crit Care. 2020 Mar 24;24(1):97. doi: 10.1186/s13054-020-2782-1. PMID: 32204721; PMCID: PMC7092484. 4. Khitar’Yan AG, Miziev IA, Provotorov ME, Veliev KS, Glumov EE, Kovalev SA, Abramyants MK, Khubiev ST. Application Of Laparoscopic Lifting Systems In Patients With High Cardiorespiratory Risk. Vestn Khir Im I I Grek. 2016;175(4):62-6. English, Russian. PMID: 30457274.