Surgical decompression for abdominal compartment syndrome in severe acute pancreatitis

Arch Surg. 2010 Aug;145(8):764-9. doi: 10.1001/archsurg.2010.132.


Hypothesis: In patients with severe acute pancreatitis and abdominal compartment syndrome, establishment of the indications and optimal time for surgical decompression may avoid exacerbation of multiple-organ dysfunction syndrome.

Design: Retrospective study.

Setting: Tertiary care university teaching hospital.

Patients: Twenty-six consecutive patients with severe acute pancreatitis and abdominal compartment syndrome treated by surgical decompression between January 1, 2002, and December 31, 2007.

Intervention: Surgical decompression of the abdomen.

Main outcome measures: Morbidity, mortality, and organ dysfunction before and after surgical decompression.

Results: At the time of surgical decompression, the median sequential organ failure assessment score among patients was 12 (interquartile range, 10-15), and the median intra-abdominal pressure was 31.5 (interquartile range, 27-35) mm Hg. After surgical decompression, renal or respiratory function was improved in 14 patients (54%). The overall hospital mortality was 46%, but mortality was 18% among 17 patients in whom surgical decompression was performed within the first 4 days after disease onset.

Conclusions: Patients with severe acute pancreatitis and abdominal compartment syndrome managed by surgical decompression had severe multiple-organ dysfunction syndrome and high mortality. Surgical decompression may improve renal or respiratory function. Early surgical decompression is associated with reduced mortality in patients with severe acute pancreatitis, early multiple-organ dysfunction syndrome, and abdominal compartment syndrome.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdomen
  • Adult
  • Compartment Syndromes / etiology
  • Compartment Syndromes / mortality
  • Compartment Syndromes / surgery*
  • Decompression, Surgical*
  • Disease Progression
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Multiple Organ Failure / prevention & control
  • Pancreatitis / complications*
  • Pancreatitis / mortality
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Risk Factors
  • Time Factors