HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) CME Credit Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Patel, A. Articles by Sandrasegaran, K. Search for Related Content PubMed PubMed Citation Articles by Patel, A. Articles by Sandrasegaran, K. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?

Abdominal Compartment Syndrome

¹ All authors: Department of Radiology, Indiana University School of Medicine, 550 N University Blvd., Suite UH 0279, Indianapolis, IN 46202.

View larger version (16K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Line diagram shows pathogenesis of abdominal compartment syndrome and sequence of events that lead to multiorgan failure. GFR = glomerular filtration rate, IVC = inferior vena cava.

View larger version (181K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —57-year-old man with diabetes who had laparotomy for infective aortitis. Scout CT image obtained 1 day after surgery shows normal position of diaphragm. Reason for horizontal artifacts on this image is not clear.

View larger version (93K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —57-year-old man with diabetes who had laparotomy for infective aortitis. Axial CT images from same series as A show ascites, normal position of diaphragm, and normal-sized inferior vena cava (IVC) (arrowhead, B). Also seen are hemoperitoneum (solid white arrow, C) and mucosal hyperenhancement of bowel (dashed arrows, C). Postoperative free peritoneal air is present. Black arrow in C indicates anteroposterior abdominal girth.

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —57-year-old man with diabetes who had laparotomy for infective aortitis. Axial CT images from same series as A show ascites, normal position of diaphragm, and normal-sized inferior vena cava (IVC) (arrowhead, B). Also seen are hemoperitoneum (solid white arrow, C) and mucosal hyperenhancement of bowel (dashed arrows, C). Postoperative free peritoneal air is present. Black arrow in C indicates anteroposterior abdominal girth.

View larger version (175K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —57-year-old man with diabetes who had laparotomy for infective aortitis. Scout image from CT obtained 7 days later shows elevated right hemidiaphragm.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2E —57-year-old man with diabetes who had laparotomy for infective aortitis. Axial CT images from same study show as D show collapsed IVC (arrowheads) with greatly increased ascites and evidence of layered hemoperitoneum (white arrows, F). Anteroposterior abdominal girth (black double arrow, F) increased from C to F. Note jejunal feeding tube (black arrow, F) and heavily calcified iliac arteries (curved arrow, F). Patient had intraabdominal hypertension (intravesical pressure of 28 mm Hg). Emergency decompressive laparotomy was performed and patient survived.

View larger version (88K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2F —57-year-old man with diabetes who had laparotomy for infective aortitis. Axial CT images from same study show as D show collapsed IVC (arrowheads) with greatly increased ascites and evidence of layered hemoperitoneum (white arrows, F). Anteroposterior abdominal girth (black double arrow, F) increased from C to F. Note jejunal feeding tube (black arrow, F) and heavily calcified iliac arteries (curved arrow, F). Patient had intraabdominal hypertension (intravesical pressure of 28 mm Hg). Emergency decompressive laparotomy was performed and patient survived.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —76-year-old woman after motor vehicle accident. Contrast-enhanced CT images show spleen is nonenhancing (white arrow, A), and grade 5 splenic injury was diagnosed. There is abdominal distention with large hematoma (solid black arrows, A and B), which displaces posteriorly and effaces stomach (containing nasogastric tube [arrowheads, A and B]). Bowel wall shows increased enhancement (arrowheads, C), and inferior vena cava (dashed arrows, A and B) and renal veins are flattened. These findings are also seen with severe hypotension (shock bowel), and imaging diagnosis of abdominal compartment syndrome cannot be made with certainty. However, at time of CT, patient was on inotropic agents and had normal renal function and blood pressure (hence decision to use IV contrast agent). In addition, intravesical pressure was 26 mm Hg, and patient underwent emergency laparotomy for splenectomy and evacuation of blood clot.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —76-year-old woman after motor vehicle accident. Contrast-enhanced CT images show spleen is nonenhancing (white arrow, A), and grade 5 splenic injury was diagnosed. There is abdominal distention with large hematoma (solid black arrows, A and B), which displaces posteriorly and effaces stomach (containing nasogastric tube [arrowheads, A and B]). Bowel wall shows increased enhancement (arrowheads, C), and inferior vena cava (dashed arrows, A and B) and renal veins are flattened. These findings are also seen with severe hypotension (shock bowel), and imaging diagnosis of abdominal compartment syndrome cannot be made with certainty. However, at time of CT, patient was on inotropic agents and had normal renal function and blood pressure (hence decision to use IV contrast agent). In addition, intravesical pressure was 26 mm Hg, and patient underwent emergency laparotomy for splenectomy and evacuation of blood clot.

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —76-year-old woman after motor vehicle accident. Contrast-enhanced CT images show spleen is nonenhancing (white arrow, A), and grade 5 splenic injury was diagnosed. There is abdominal distention with large hematoma (solid black arrows, A and B), which displaces posteriorly and effaces stomach (containing nasogastric tube [arrowheads, A and B]). Bowel wall shows increased enhancement (arrowheads, C), and inferior vena cava (dashed arrows, A and B) and renal veins are flattened. These findings are also seen with severe hypotension (shock bowel), and imaging diagnosis of abdominal compartment syndrome cannot be made with certainty. However, at time of CT, patient was on inotropic agents and had normal renal function and blood pressure (hence decision to use IV contrast agent). In addition, intravesical pressure was 26 mm Hg, and patient underwent emergency laparotomy for splenectomy and evacuation of blood clot.

View larger version (153K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —20-year-old woman who presented with traumatic placental abruption at 26 weeks' gestation. CT was performed to exclude trauma to abdominal organs. Contrast-enhanced CT images show high-density peritoneal fluid (white arrows, A and B) indicating hemoperitoneum. Bowel walls are thickened and show increased enhancement (black arrows, A and B). Inferior vena cava is collapsed (black arrowheads, A and B). Extravasation of IV contrast material is seen in placenta (white arrowheads, C). Intravesical pressure was 29 mm Hg. Patient was moribund and underwent emergency cesarean section. She died 2 days later of multiorgan failure.

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —20-year-old woman who presented with traumatic placental abruption at 26 weeks' gestation. CT was performed to exclude trauma to abdominal organs. Contrast-enhanced CT images show high-density peritoneal fluid (white arrows, A and B) indicating hemoperitoneum. Bowel walls are thickened and show increased enhancement (black arrows, A and B). Inferior vena cava is collapsed (black arrowheads, A and B). Extravasation of IV contrast material is seen in placenta (white arrowheads, C). Intravesical pressure was 29 mm Hg. Patient was moribund and underwent emergency cesarean section. She died 2 days later of multiorgan failure.

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —20-year-old woman who presented with traumatic placental abruption at 26 weeks' gestation. CT was performed to exclude trauma to abdominal organs. Contrast-enhanced CT images show high-density peritoneal fluid (white arrows, A and B) indicating hemoperitoneum. Bowel walls are thickened and show increased enhancement (black arrows, A and B). Inferior vena cava is collapsed (black arrowheads, A and B). Extravasation of IV contrast material is seen in placenta (white arrowheads, C). Intravesical pressure was 29 mm Hg. Patient was moribund and underwent emergency cesarean section. She died 2 days later of multiorgan failure.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —50-year-old man after motor vehicle accident. Contrast-enhanced CT images show extensive hemoperitoneum in right upper quadrant (white arrowheads). Note right rib fracture on A. Liver dome is superiorly positioned in relation to heart in A, indicating right hemidiaphragmatic elevation. There is inhomogeneous and patchy hepatic enhancement. Inferior vena cava is collapsed (black arrowhead, B). Grade 5 liver trauma was diagnosed. Intravesical pressure was 32 mm Hg. Patient underwent emergency laparotomy but died soon afterward.

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —50-year-old man after motor vehicle accident. Contrast-enhanced CT images show extensive hemoperitoneum in right upper quadrant (white arrowheads). Note right rib fracture on A. Liver dome is superiorly positioned in relation to heart in A, indicating right hemidiaphragmatic elevation. There is inhomogeneous and patchy hepatic enhancement. Inferior vena cava is collapsed (black arrowhead, B). Grade 5 liver trauma was diagnosed. Intravesical pressure was 32 mm Hg. Patient underwent emergency laparotomy but died soon afterward.

View larger version (169K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —54-year-old man who underwent orthotopic liver transplantation. Scout radiograph (A) and axial CT scan (B) performed 3 days after liver transplantation show elevated left hemidiaphragm (arrow, A) and collapsed inferior vena cava (arrowhead, B). Note severe ascites in B. Intravesical pressure was elevated (21 mm Hg).

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —54-year-old man who underwent orthotopic liver transplantation. Scout radiograph (A) and axial CT scan (B) performed 3 days after liver transplantation show elevated left hemidiaphragm (arrow, A) and collapsed inferior vena cava (arrowhead, B). Note severe ascites in B. Intravesical pressure was elevated (21 mm Hg).

View larger version (78K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —54-year-old man who underwent orthotopic liver transplantation. Color Doppler sonogram shows virtually no diastolic flow in main hepatic artery. In fact, initial reversal of diastolic flow (arrows) is seen.

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —54-year-old man who underwent orthotopic liver transplantation. Patient underwent therapeutic paracentesis with drainage of 10.5 L of serous fluid. Postdrainage scout radiograph (same magnification as scout image A) shows return of diaphragm to normal position and reduced distention. Skin folds (arrowheads) were seen after acute abdominal decompression. Decompressive surgery was not required. Abdominal compartment syndrome is rare in patients undergoing liver transplantation at our institution, possibly because fascia is routinely left open, and skin is sutured. After satisfactory postoperative recovery, fascia and skin are closed a few days later.

View larger version (166K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —67-year-old man who presented with severe acute pancreatitis. Scout image shows elevated diaphragm (arrow) and abdominal distention.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —67-year-old man who presented with severe acute pancreatitis. CT image shows inferior vena cava (arrowhead) is collapsed. IV contrast material was not given due to renal dysfunction.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —67-year-old man who presented with severe acute pancreatitis. CT image shows severe pancreatic ascites. Ratio of maximum anteroposterior girth to lateral abdominal girth is 0.65 (double-headed arrows).

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati