Abdominal Compartment Syndrome

ACS is often overlooked. Diagnosis requires a high index of suspicion due to underlying disease (bowel ischemia) or who requires extensive fluid resuscitation (severe pancreatitis, sepsis, major burns) - Mark Ramsey DO & Nick Mark MD

Abdominal Compartment Syndrome
Abdominal Compartment Syndrome

image by: LearnPICU

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Under Pressure: Abdominal Compartment Syndrome

Because ACS often occurs in patients who are critically ill and unable to communicate, it becomes extremely important to understand and identify early warning signs of IAH. The three cardinal signs of ACS are worsening abdominal distension, difficulty breathing or elevated peak pressures on the ventilator, and decreased urine output. Other clinical signs include mental confusion, worsening hypoxia, hypotension, tachycardia, and jugular venous distention.

Measurement of the IAP is needed for definitive diagnosis, and the gold standard is measurement of bladder pressure using a Foley catheter and a transducer or manometer. Remember, ACS is not a diagnosis made on computed tomography (CT)…

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 Under Pressure: Abdominal Compartment Syndrome

Remember, ACS is not a diagnosis made on computed tomography (CT) scan! Several commercialized kits are available for the measurement of intravesical pressure, however an easy method that can be used in the emergency department involves instilling 50 ml saline into the bladder via the catheter, clamping the tubing of the collecting bag, inserting a needle through the specimen-collecting port and then attaching to a manometer.

American Journal of Roentgenology

Compartment syndrome is well known in the extremities, where increased pressure within a closed fascial space depresses capillary perfusion pressure to a level that cannot maintain tissue viability. The effects of elevated intraabdominal pressure are less well recognized. Normally, the abdominal pressure is about 5 mm Hg. The intraabdominal pressure may increase with acute and substantial accumulation of fluid within the abdomen. “Abdominal compartment syndrome” is defined as intraabdominal pressure of at least 20 mm Hg with dysfunction of at least one thoracoabdominal organ.


Hold foley tubing straight up from symphysis pubis, height of urine column is the pressure. If there is no urine, instill 100 cc of saline. Comparable accuracy to other standard techniques.

Deranged Physiology

Abdominal compartment syndrome is a complication of torso trauma and abdominal catastrophe...

Life in the Fastlane

Gold standard is measurement of intra-vesical pressure...

Open Anesthesia

Abdominal compartment syndrome (ACS) is a potentially life-threatening illness that results from the persistent and pathological elevation of IAP above 20mmHg that is associated with new organ dysfunction.


Abdominal compartment syndrome is a disease defined by the presence of new end-organ dysfunction secondary to elevated intra-abdominal pressure. Radiological diagnosis is difficult and usually suggested when a collection of imaging findings are present in the appropriate clinical setting or if the signs on sequential imaging studies are seen to progress. Diagnosis is usually clinically supported by elevated intravesicular pressure which closely parallels intra-abdominal compartment pressure.


ACS is usually only observed in critically ill patients and is more frequently diagnosed in the intensive care unit (ICU) than in the emergency department. Of note, physical examination is not a reliable indicator of ACS, even when performed by experienced clinicians,

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