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Intra-Abdominal Hypertension: A Systemic Complication of Severe Acute Pancreatitis

Patients with severe acute pancreatitis (SAP) present complications and organ failure, which require treatment in critical care units. These extrapancreatic complications determine the clinical outcome of the disease. Intra-abdominal hypertension (IAH) deteriorates the prognosis of SAP. In this pape...

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Autores principales: Mancilla Asencio, Carla, Berger Fleiszig, Zoltán
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9229825/
https://www.ncbi.nlm.nih.gov/pubmed/35744049
http://dx.doi.org/10.3390/medicina58060785
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author Mancilla Asencio, Carla
Berger Fleiszig, Zoltán
author_facet Mancilla Asencio, Carla
Berger Fleiszig, Zoltán
author_sort Mancilla Asencio, Carla
collection PubMed
description Patients with severe acute pancreatitis (SAP) present complications and organ failure, which require treatment in critical care units. These extrapancreatic complications determine the clinical outcome of the disease. Intra-abdominal hypertension (IAH) deteriorates the prognosis of SAP. In this paper, relevant recent literature was reviewed, as well as the authors’ own experiences, concerning the clinical importance of IAH and its treatment in SAP. The principal observations confirmed that IAH is a frequent consequence of SAP but is practically absent in mild disease. Common manifestations of AP such as pain, abdominal distension, and paralytic ileus contribute to increased abdominal pressure, as well as fluid loss in third space and aggressive fluid replacement therapy. A severe increase in IAP can evolve to abdominal compartment syndrome and new onset organ failure. Conservative measures are useful, but invasive interventions are necessary in several cases. Percutaneous drainage of major collections is preferred when possible, but open decompressive laparotomy is the final possibility in some cases in order to definitively reduce abdominal pressure. Intra-abdominal pressure should be measured in all SAP cases that worsen despite adequate treatment in critical care units. Conservative measures must be introduced to treat IAH, including negative fluid balance, digestive decompression by gastric–rectal tube, and prokinetics, including neostigmine. In the case of insufficient responses to these measures, minimally invasive interventions should be preferred.
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spelling pubmed-92298252022-06-25 Intra-Abdominal Hypertension: A Systemic Complication of Severe Acute Pancreatitis Mancilla Asencio, Carla Berger Fleiszig, Zoltán Medicina (Kaunas) Review Patients with severe acute pancreatitis (SAP) present complications and organ failure, which require treatment in critical care units. These extrapancreatic complications determine the clinical outcome of the disease. Intra-abdominal hypertension (IAH) deteriorates the prognosis of SAP. In this paper, relevant recent literature was reviewed, as well as the authors’ own experiences, concerning the clinical importance of IAH and its treatment in SAP. The principal observations confirmed that IAH is a frequent consequence of SAP but is practically absent in mild disease. Common manifestations of AP such as pain, abdominal distension, and paralytic ileus contribute to increased abdominal pressure, as well as fluid loss in third space and aggressive fluid replacement therapy. A severe increase in IAP can evolve to abdominal compartment syndrome and new onset organ failure. Conservative measures are useful, but invasive interventions are necessary in several cases. Percutaneous drainage of major collections is preferred when possible, but open decompressive laparotomy is the final possibility in some cases in order to definitively reduce abdominal pressure. Intra-abdominal pressure should be measured in all SAP cases that worsen despite adequate treatment in critical care units. Conservative measures must be introduced to treat IAH, including negative fluid balance, digestive decompression by gastric–rectal tube, and prokinetics, including neostigmine. In the case of insufficient responses to these measures, minimally invasive interventions should be preferred. MDPI 2022-06-10 /pmc/articles/PMC9229825/ /pubmed/35744049 http://dx.doi.org/10.3390/medicina58060785 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Mancilla Asencio, Carla
Berger Fleiszig, Zoltán
Intra-Abdominal Hypertension: A Systemic Complication of Severe Acute Pancreatitis
title Intra-Abdominal Hypertension: A Systemic Complication of Severe Acute Pancreatitis
title_full Intra-Abdominal Hypertension: A Systemic Complication of Severe Acute Pancreatitis
title_fullStr Intra-Abdominal Hypertension: A Systemic Complication of Severe Acute Pancreatitis
title_full_unstemmed Intra-Abdominal Hypertension: A Systemic Complication of Severe Acute Pancreatitis
title_short Intra-Abdominal Hypertension: A Systemic Complication of Severe Acute Pancreatitis
title_sort intra-abdominal hypertension: a systemic complication of severe acute pancreatitis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9229825/
https://www.ncbi.nlm.nih.gov/pubmed/35744049
http://dx.doi.org/10.3390/medicina58060785
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