同: ACS

WordNet

the muscles of the abdomen (同)abdominal_muscle, ab
of or relating to or near the abdomen; "abdominal muscles"
a pattern of symptoms indicative of some disease
a complex of concurrent things; "every word has a syndrome of meanings"
a partitioned section, chamber, or separate room within a larger enclosed area
a space into which an area is subdivided
divided up or separated into compartments or isolated units; "a compartmented box"; "the protected and compartmented society of Beacon Hill"- John Mason Brown

PrepTutorEJDIC

(比較変化なし)腹の,腹部の
(疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態
区画,仕切り / (客車の)個室;(船の)隔室

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/01/23 11:13:38」(JST)

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Abdominal compartment syndrome occurs when the abdomen becomes subject to increased pressure. Specific cause of abdominal compartment syndrome is not known, although some causes can be sepsis and severe abdominal trauma. Increasing pressure reduces blood flow to abdominal organs and impairs pulmonary, cardiovascular, renal, and gastro-intestinal (GI) function, causing multiple organ dysfunction syndrome and death.^[1]

Pathophysiology

It occurs when tissue fluid within the peritoneal and retroperitoneal space (either edema, retroperitoneal blood or free fluid in the abdomen) accumulates in such large volumes that the abdominal wall compliance threshold is crossed and the abdomen can no longer stretch. Once the abdominal wall can no longer expand, any further fluid leaking into the tissue results in fairly rapid rises in the pressure within the closed space. Initially this increase in pressure does not cause organ failure but does cause organs to not work properly - this is called intra-abdominal hypertension and is defined as a pressure over 12 mm Hg in adults. However, if the pressure continues to rise over 20 mm Hg and organs begin to fail, the syndrome has now progressed to the end stage highly fatal process termed abdominal compartment syndrome. These pressure measurements are relative. Small children get into trouble and develop compartment syndromes at much lower pressures while young previously healthy athletic individuals may tolerate an abdominal pressure of 20 mm Hg very well. The diagram provided here shows more details regarding the pathophysiology of this process. The underlying cause of the disease process is capillary permeability caused by the systemic inflammatory response syndrome (SIRS) that occurs in every critically ill patient. SIRS leads to leakage of fluid out of the capillary beds into the interstitial space in the entire body with a profound amount of this fluid leaking into the gut wall, mesentery and retroperitoneal tissue. (For a much more extensive discussion on the topic and physiology visit the Wikipedia section discussing intra-abdominal hypertension.)

Peritoneal tissue edema secondary to diffuse peritonitis, abdominal trauma,
Fluid therapy due to massive volume resuscitation
Retroperitoneal hematoma secondary to trauma and aortic rupture
Peritoneal trauma secondary to emergency abdominal operations
Reperfusion injury following bowel ischemia due to any cause
Retroperitoneal and mesenteric inflammatory edema secondary to acute pancreatitis
Ileus and bowel obstruction
Intraabdominal masses of any etiology
Abdominal packing for control of hemorrhage
Closure of the abdomen under undue tension
Ascites / intraabdominal fluid accumulation^[2]

Abdominal compartment syndrome follows a destructive pathway similar to compartment syndrome of the extremities. When increased compression occurs in such a hollow space organs will begin to collapse under the pressure. As the pressure increases and reaches a point where the abdomen can no longer be distended it starts to affect the cardiovascular and pulmonary systems. When abdominal compartment syndrome reaches this point without surgery and help of a silo the patient will most likely die. There is a high mortality rate associated with abdominal compartment syndrome.^[1]^[3]^[4]

Treatment

Non-operative medical management

There are now multiple papers noting that early intervention using medical management for intra-abdominal hypertension can prevent abdominal compartment syndrome from occurring and can result in reduced costs of care. All of these papers suggest early detection of elevated intraabdominal pressure via bladder pressure monitoring and introduction of a treatment protocol are required for optimal results.^[5]^[6]^[7]^[8]^[9] A very nice review of medical management for IAH / ACS was published by Dr. Mike Cheatham in 2009 and Dr. De Keulenaer in 2011.^[10]^[11] Furthermore, visiting the website of the World Society of Abdominal compartment syndrome allows one to download assessment and management algorithms free of charge.^[12] More detailed information on medical management for this syndrome can be found on the intraabdominal hypertension page

Finally - the diagrams and algorithm provided here are useful items to assist in evaluation and management of these complex patients.

Treatment algorithm for IAH/ ACS

Operative decompression

Surgical decompression can be achieved by opening the abdominal wall and abdominal fascia anterior in order to physically create more space for the abdominal viscera. Once opened, the fascia can be bridged for support and to prevent loss of domain by a variety of medical devices (Bogota bag, artificial bur, and vacuum devices using negative pressure wound therapy ^[13]).

References

^ ^a ^b http://findarticles.com/p/articles/mi_qa3689/is_200401/ai_n9346109/
^ [J Intensive Care Med 2000;15:201-220]
^ http://emedicine.medscape.com/article/829008-overview
^ http://www.abdominalcompartmentsyndrome.com/
^ Cheatham ML, Safcsak K. Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival? Critical care medicine 2010;38:402-7.
^ Kimball EJ, Mone M, Hansen H, et al. A prospective evaluation of the protocolized management of intra-abdominal hypertension and the abdominal compartment syndrome. Acta Clinica Belgica 2009;64:272 - Abstract 110.
^ Sun ZX, Huang HR, Zhou H. Indwelling catheter and conservative measures in the treatment of abdominal compartment syndrome in fulminant acute pancreatitis. World J Gastroenterol 2006;12:5068-70.
^ Oda S, Hirasawa H, Shiga H, et al. Management of Intra-abdominal Hypertension in Patients With Severe Acute Pancreatitis With Continuous Hemodiafiltration Using a Polymethyl Methacrylate Membrane Hemofilter. Ther Apher Dial 2005;9:355-61.
^ Ennis JL, Chung KK, Renz EM, et al. Joint Theater Trauma System implementation of burn resuscitation guidelines improves outcomes in severely burned military casualties. The Journal of trauma 2008;64:S146-51.
^ Cheatham ML. Nonoperative management of intraabdominal hypertension and abdominal compartment syndrome. World J Surg 2009;33:1116-22.
^ De Keulenaer BL, De Waele JJ, Malbrain ML. Nonoperative management of intra-abdominal hypertension and abdominal compartment syndrome: evolving concepts. The American surgeon 2011;77 Suppl 1:S34-41.
^ [1] WSACS.org
^ Fitzgerald JEF, Gupta S, Masterson S, Sigurdsson HH. Laparostomy Management using the ABThera™ Open Abdomen Negative Pressure Therapy System in a Grade IV Open Abdomen Secondary to Acute Pancreatitis. International Wound Journal 2012. PMID: 22487377

External links

openabdomen.org

UpToDate Contents

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1. 腹部コンパートメント症候群 abdominal compartment syndrome
2. 血管内腹部大動脈修復術の合併症 complications of endovascular abdominal aortic repair
3. 腹部大動脈瘤破裂の外科的および血管内修復 surgical and endovascular repair of ruptured abdominal aortic aneurysm
4. 成人におけるopen abdomen（閉腹しない状態）のマネージメント management of the open abdomen in adults
5. 肝障害のマネージメントのための外科手技 surgical techniques for managing hepatic injury

English Journal

Significance of measurements of herniary area and volume and abdominal cavity volume in the treatment of incisional hernia: Application of CT 3D reconstruction in 17 cases.

Yao S, Li JY, Liu FD, Pei LJ.SourceDepartment of General Surgery, 304 Clinical Department, General Hospital of PLA , Beijing , China.
Computer aided surgery : official journal of the International Society for Computer Aided Surgery.Comput Aided Surg.2012;17(1):40-5.
Objective: To investigate the value of CT 3D reconstruction in the diagnosis and treatment of incisional hernia and the related factor of abdominal cavity volume. Methods: Abdominal wall defect and herniary volume were measured using 3D reconstruction based on plain CT scans in 17 patients with in
PMID 22145789

Response to comment on "intraabdominal hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm".

Björck M, Djavani Gidlund K, Wanhainen A.SourceDepartment of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden.
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.Eur J Vasc Endovasc Surg.2012 Jan;43(1):132. Epub 2011 Oct 26.
PMID 22032968