ACA App
Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia
Home | About us | Editorial Board | Search | Ahead of print | Current Issue | Archives | Submission | Subscribe | Advertise | Contact | Login 
Users online: 804 Small font size Default font size Increase font size Print this article Email this article Bookmark this page
 


 

 
     
    Advanced search
 

 
 
     
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Case Report
    References
    Article Figures

 Article Access Statistics
    Viewed122    
    Printed0    
    Emailed0    
    PDF Downloaded16    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents
INTERESTING IMAGE  
Year : 2018  |  Volume : 21  |  Issue : 4  |  Page : 444-445
Abdominal compartment syndrome after surgical repair of Type A aortic dissection


Department of Cardiothoracic Surgery, G. Papanikolaou General Hospital, Thessaloniki, Greece

Click here for correspondence address and email

Date of Web Publication17-Oct-2018
 

   Abstract 


Abdominal compartment syndrome is associated with severe dysfunction of intra-abdominal and intrathoracic organs. Medical therapy, with the goal of reducing intra-abdominal pressure, leads to improvement in organ perfusion.

Keywords: Abdominal compartment syndrome, aortic dissection, postoperative care

How to cite this article:
Ampatzidou F, Madesis A, Kechagioglou G, Drossos G. Abdominal compartment syndrome after surgical repair of Type A aortic dissection. Ann Card Anaesth 2018;21:444-5

How to cite this URL:
Ampatzidou F, Madesis A, Kechagioglou G, Drossos G. Abdominal compartment syndrome after surgical repair of Type A aortic dissection. Ann Card Anaesth [serial online] 2018 [cited 2018 Dec 17];21:444-5. Available from: http://www.annals.in/text.asp?2018/21/4/444/243542





   Case Report Top


A 67-year-old female underwent surgical repair for acute Stanford Type A dissection. Ascending aorta was replaced with a tube graft (Cardiopulmonary Bypass Time 233 min, Aortic Cross Clamp Time 119 min). During the 3rd postoperative day, the patient developed an acute kidney injury, as well as elevated liver transaminase, was noted. Intra-abdominal pressure (IAP) measured through urinary bladder catheter was found to be 20–23 mmHg [Figure 1]. In 2006, World Society of the Abdominal Compartment Syndrome defined this syndrome as a condition where IAP is more than 20 mmHg (with or without abdominal perfusion pressure <60 mmHg) and is accompanied by organ dysfunction.
Figure 1: Intra-abdominal pressure measurement (via urinary bladder catheter)

Click here to view


Postoperative abdominal compartment syndrome is not unusual and can be caused due to capillary leak, ischemia-reperfusion injury, and massive fluid resuscitation.[1],[2] To exclude mesenteric ischemia and visceral malperfusion syndrome, abdominal computed tomography angiography (CTA) was performed. The CTA revealed a dissected descending abdominal aorta extending to the right common iliac artery. The celiac trunk, the superior mesenteric, and the right renal artery arose from the true lumen. The inferior mesenteric and left renal arose from the false lumen. A severe narrowing of the origin of the celiac trunk [[Figure 2]-red arrow] was observed, and the true lumen was markedly compressed by the false lumen [[Figure 2]-black arrow].
Figure 2: Celiac track. Narrowing of the origin (red arrow) true lumen-T compression by the false lumen-F (black arrow). Intestinal dilatation

Click here to view


Taking this information into account, we deduced that the vessels although stenotic were patent and that an increase in IAP may further reduce arterial flow to the abdomen. We decided to pursue conservative management comprising of early initiation of renal replacement therapy, negative fluid balance, sedation, paralysis, GI tract decompression (nasogastric and rectal tubes, enemas, and neostigmine for bowel distension), and maintenance of higher abdominal perfusion pressure. The patient got progressively better and made a complete recovery.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Loftus IM, Thompson MM. The abdominal compartment syndrome following aortic surgery. Eur J Vasc Endovasc Surg 2003;25:97-109.  Back to cited text no. 1
    
2.
Djavani Gidlund K, Wanhainen A, Björck M. Intra-abdominal hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 2011;41:742-7.  Back to cited text no. 2
    

Top
Correspondence Address:
Fotini Ampatzidou
Department of Cardiothoracic Surgery, G. Papanikolaou General Hospital, Exohi, 57010, Thessaloniki
Greece
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_247_17

Rights and Permissions


    Figures

  [Figure 1], [Figure 2]



 

Top