Tavares-de la Paz LA, Sánchez-Fernández P, Salazar-Lozano C, Salazar-Murillo H

Idioma: Español
Referencias bibliográficas: 33
Paginas: 515-518
Archivo PDF: 44.48 Kb.

RESUMEN

Introducción: Son diversos los informes acerca de la presencia de síndrome compartimental abdominal (SCA) en pacientes con pancreatitis aguda grave. El tratamiento agresivo del SCA mediante la realización de una laparotomía descompresiva formal, evacuación del líquido de ascitis y cierre temporal de la pared abdominal, se ha asociado con mejoría instantánea de todos los parámetros fisiológicos del paciente en estado crítico. Sin embargo, la morbilidad y mortalidad asociadas son inaceptablemente altas.
Casos clínicos: Dos pacientes con pancreatitis aguda grave y SCA en quienes se logró descompresión abdominal exitosa mediante la evacuación de líquido de ascitis con la colocación de un catéter peritoneal, apreciando una significante disminución de la presión intraabdominal y disminución de los parámetros del ventilador. Lo anterior permitió evitar por completo la cirugía en un paciente y retrasarla de manera significativa en otro.
Conclusiones: La descompresión abdominal mediante la evacuación del líquido de ascitis a través de un catéter peritoneal en pacientes con pancreatitis aguda grave y SCA (secundario a una obligada resucitación hídrica masiva), es una opción terapéutica útil y segura para disminuir la presión intraabdominal y retrasar o evitar por completo una laparotomía con cierre temporal de la pared abdominal.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Rocco O III, Eddy VA, Jacobs LM Jr, Stadelmann WK. The abdominal compartment syndrome. Arch Surg 2004;139:415-422.

2. Hunter JD, Damani Z. Intra-abdominal hypertension and the abdominal compartment syndrome. Anesthesia 2004;59:899-907.

3. Moore AFK, Hargest R, Martin M, Delicata RJ. Intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 2004;91:1102-1110.

4. Malbrain M. Incidence of intraabdominal hypertension in the intensive care unit. Crit Care Med 2005;33:2150-2153.

5. World Society of The Abdominal Compartment Syndrome. WSACS Consensus Guidelines Summary. [Available at http://www.wsacs.org]

6. Bradley-Stevenson C, Vyas H. Intra-abdominal hypertension and the abdominal compartment syndrome. Curr Ped 2004;14:191-196.

7. Sugrue M, Jones F, Deane SA, Bishop G, Bauman A, Hillman K, et al. Intra-abdominal hypertension is an independent cause of postoperative renal impairment. Arch Surg 1999;134:1082-1085.

8. Sugrue M, Hourihan F, Buist, Deane S, Bauman A, Hillman K. Prospective study of intra-abdominal hypertension and renal function after laparotomy. Br J Surg 1995;82:235-238.

9. Saggi B, Sugerman H, Ivatury R. Abdominal compartment syndrome. J Trauma 1998;597-609.

10. Maxwell R, Fabian T, Croce M, Davis K. Secondary abdominal compartment syndrome: an underappreciated manifestation of severe hemorrhagic shock. J Trauma 1999;47:995.

11. Gracias V, Braslow B, Johnson J, Pryor J, Gupta R, Reilly P, Schwab CW. Abdominal compartment syndrome in the open abdomen. Arch Surg 2002;137:1298-1300.

12. McNelis J, Marini Corrado P, Jurkiewicz A, Fields S, Caplin D, Stein D, et al. Predictive factors associated with the development of abdominal compartment syndrome in the surgical intensive care unit. Arch Surg 2002;137:133-136.

13. Mayberry JC, Welker KJ, Goldman R, Mullins R. Mechanism of acute ascites formation after trauma resuscitation. Arch Surg 2003;138:773-776.

14. Daugherty E, Liang H, Taichman D, Hansen F, Fuchs B. Abdominal compartment syndrome is common in medical ICU patients receiving large volume resuscitation. Crit Care Med 32;12(suppl):A83.

15. Ivatury RR, Richmond V. Supranormal trauma resuscitation and abdominal compartment syndrome. Arch Surg 2004;139:225.

16. Kopelman T, Harris C, Miller R, Arrillaga A. Abdominal compartment syndrome with isolated extraperitoneal injuries. J Trauma 2000;49:744-749.

17. Oda S, Hirasawa H, Shiga H, Matsuda K, Nakamura M, Watanabe E, et al. Management of intra-abdominal hypertension in patients with severe acute pancreatitis with continuous hemodiafiltration using a polymethyl methacrylate membrane hemofilter. Therapeutic Apheresis Dial 2005;9:355-361.

18. Keskinen P, Leppaniemi V, Pettila E, Kemppainen A, Piilonen M, Hynnienet al. Intra-abdominal hypertension in acute necrotizing pancreatitis. ANZ J Surg 2005;75:A3-A4.

19. Lisi M, Sne N, Baillie F, Cadeddu M. Computed tomography guided percutaneous drainage of the abdominal cavity is a safe alternative to celiotomy in patients with abdominal compartment syndrome due to severe phlegmenous pancreatitis. A case report. ANZ J Surg 2005;75:A2.

20. Reckard J, Chung M, Varma M, Zagorski M. Management of intraabdominal hypertension by percutaneous catheter drainage. J Vasc Inter Radiol 2005;16:1019-1021.

21. De Waele J, Hoste E, Blot J, Decruyenaere F, Colardyn. Intraabdominal hypertension and severe acute pancreatitis. ANZ J Surg 2005;75:A21.

22. Gecelter G, Fahoum B, Gardezi S, Schein M. Abdominal compartment syndrome in severe acute pancreatitis: an indication for decompressing laparotomy? Dig Surg 2002;19:402-405.

23. Hobson K, Young K, Ciraulo A, Palmieri T, Greenhagh. Release of abdominal compartment syndrome improves survival in patients with burn injury. J Trauma 2002;53:1129-1134.

24. Tsiotos G, Smith CD, Sarr M. Incidence and management of pancreatic and enteric fistulas after surgical management of severe necrotizing pancreatitis. Arch Surg 1995;130:48-52.

25. Stone PA, Hass SM, Flaherty SK, DeLuca JA, Lucente FC, Kusminsky RE. Vacuum-assisted fascial closure for patients with abdominal trauma. J Trauma 2004;57:1082-1086.

26. Howdieshell TR, Proctor CD, Sternberg E, Cué JI, Mondy JS, Hawkins ML. Temporary abdominal closure followed by definitive abdominal wall reconstruction of the open abdomen. Am J Surg 2004;188:301-306.

27. Losanoff JE, Richman BW, Jones JW. Temporary abdominal coverage and reclosure of the open abdomen: frequently asked questions. J Am Coll Surg 2002;195:105-114.

28. Tremblay L, Feliciano DV, Schmidt J, Cava RA, Tchorz KM, Ingram WL, et al. Skin only or silo closure in the critically ill patient with an open abdomen. Am J Surg 2001;182:670-675.

29. Bradley E. A clinically based classification system for acute pancreatitis. Summary of the International Symposium of Acute Pancreatitis, Atlanta, GA, September 11-13, 1992. Arch Surg 1993;128:586-590.

30. Fusco M, Martin S, Chang M. Estimation of intra-abdominal pressure by bladder pressure measurement: validity and methodology. J Trauma 2001;50:297-302.

31. Parra M, Al-Khayat H, Smith H, Cheatman M. Paracentesis for resuscitationinduced abdominal compartment syndrome: an alternative laparotomy in the burn patient. J Trauma 2006;60:1119-1121.

32. Corcos A, Sherman H. Percutaneous treatment of secondary abdominal compartment syndrome. J Trauma 2001;51:1062-1064.

33. Wondberg D, Zingg U, Metzger U, Platz A. VAC abdominal dressing system in left open abdomen patients with secondary peritonitis. Br J Surg 2006;93:1161. J Trauma 2000;49:621-627.