Mihailo Bezmarevic
University of Defense Serbia
Title: Clinical significance and dilemmas in management of abdominal compartment syndrome in severe acute pancreatitis
Biography
Biography: Mihailo Bezmarevic
Abstract
There is growing evidence in the literature that development of abdominal compartment syndrome (ACS) in patients with severe acute pancreatitis (SAP) has a strong impact on the course of disease. Incidence of ACS in patients with SAP is around 20%. In recent published review the mortality rate in patients who developed ACS during SAP is 49%, while it is 11% in patients without this complication. Due to more aggressive fluid resuscitation, a bigger proportion of patients treated conservatively or by a minimal invasive approach, and efforts to delay open surgery, the number of patients with ACS has increased. The development of organ failure in SAP is in correlation with presence of intra-abdominal hypertension (IAH). IAH can deteriorate already compromised pancreatic perfusion and perfusion of gut in early stages of SAP. It may increase the necrosis of pancreatic tissue and could contribute in bacterial translocation from gut with a higher incidence of infective complications and sepsis. The existence of ACS complicates the treatment of SAP itself including fluid resuscitation, nutritional support and planning for minimal invasive approach for necrotizing pancreatitis. If conservative treatments do not alleviate IAH, interventional procedures should be considered. So far, there have not been standard recommendations for surgical or some other interventional treatment of patients who develop ACS during the course of SAP. Several interventional procedures were proposed but the surgical technique used should be individualized in each patient. The complexity associated with ACS management calls for the multi-disciplinary team approach involving interventional radiologists, surgeons and intensivists.