Hernia (2008) 12:613–620 DOI 10.1007/s10029-008-0394-9
O R I G I N A L A R T I CL E
Abdominal compartment syndrome in patients with strangulated hernia M. A. Beltrán · R. A. Villar · K. S. Cruces
Received: 11 January 2008 / Accepted: 26 May 2008 / Published online: 6 August 2008 © Springer-Verlag 2008
Abstract Background Intestinal obstruction (IO) leads to increased intra-abdominal pressure and abdominal compartment syndrome. The purpose of this study was to investigate the characteristics of abdominal compartment syndrome in patients with IO secondary to strangulated hernia. Methods We studied 81 consecutive unselected patients presenting complicated hernias and IO. We measured intraabdominal pressure using the intra-vesicular pressure method. Results Preoperative (15 min) intra-abdominal pressure was higher in patients with strangulated hernias. Postoperative (15 min) intra-abdominal pressure in both groups decreased to similar values. Intra-abdominal pressure was measured during the preoperative period in patients with strangulated hernias and during the postoperative period at 15 min (13.8 § 6.4 mmHg), 24 h (9.8 § 3.2 mmHg) and 48 h (7.4 § 2.4 mmHg). Abdominal compartment syndrome developed in 47% cases with strangulated hernias with a mortality of Wve patients. Conclusions Serial measurements of intra-abdominal pressure evidenced the clinical severity of strangulated
This work was read at the XVII Latin American surgical congress of FELAC (Latin American Surgical Federation) held in Santiago, Chile, 18–22 November 2007. M. A. Beltrán · K. S. Cruces Department of Surgery, Hospital de Ovalle, Ovalle, Chile M. A. Beltrán · R. A. Villar Emergency Unit, Hospital de Ovalle, Ovalle, Chile M. A. Beltrán (&) P.O. Box 912, Manuel Antonio Caro 2629, San Joaquín, La Serena, Región de Coquimbo, Chile e-mail:
[email protected]
hernia. Intra-abdominal pressure measurement may be used as a predictor of intestinal strangulation in patients presenting acute abdominal compartment syndrome secondary to complicated hernia. Keywords Abdominal compartment syndrome · Intestinal obstruction · Strangulated hernia · Intra-abdominal pressure
Introduction Intestinal obstruction (IO) is a well-known cause of increased intra-abdominal pressure (IAP); if it is not treated early, it leads to abdominal compartment syndrome (ACS), irreversible multiple organ dysfunction syndrome (MODS) and eventually death [1–6]. In addition to the ischemia present in IO, bowel tissue oxygenation decreases as a consequence of IAP [7], resulting in visceral edema and bacterial translocation leading to peritonitis, sepsis and MODS [4, 5]. Most studies and series report postoperative adhesions as the Wrst cause of IO in adults [8–11], and incarcerated or strangulated abdominal wall hernia as the second [8, 10], or fourth most common cause [9]. Recent publications have reported strangulated hernia, together with adhesions, as the leading cause of IO [12–14]. Most importantly, complicated hernia has been reported as the most common cause of small bowel strangulation [13]. At our institution, strangulated hernia has accounted for 45% of all surgical interventions for IO during the last 10 years [14]. Studies investigating IAP and ACS in patients with hernia focus on the appropriate technique and the consequences of tension repairs of large incisional hernias [15]. We did not Wnd any publications regarding the characteristics of IAP and ACS in patients presenting IO secondary to complicated hernia.
123
614
Complicated hernia is deWned as any incarcerated or strangulated abdominal wall hernia. Incarceration is deWned as irreducibility of an external hernia, and strangulation as an irreducible hernia with objective signs of ischemia and necrosis [16, 17]. The purpose of this study was to investigate the characteristics of IAP and ACS in patients with IO secondary to complicated abdominal wall hernia.
Hernia (2008) 12:613–620
culture aspiration port and connected to the catheter; a three-way stopcock added between the catheter and the drainage bag served as a connector to a pressure transducer that recorded the IAP (in mm Hg). IAP was measured with the patient in a supine position with the level of the midaxillary line as the zero reference point. ClassiWcation of ACS
Patients and methods From July 2004 to August 2006, we prospectively studied a cohort of 81 consecutive unselected patients presenting complicated hernia and IO at our institution, and followed with serial measurements of IAP during 48 h. In 32 patients (39%) the cause of IO was strangulated hernia. For the purpose of this study, we divided the cohort into two groups: patients with strangulated hernias and patients with incarcerated hernias. Most patients (51%) were female. The median age of the cohort was 62 § 16 years; patients with strangulated hernias were older than patients with incarcerated hernias. The period from initial symptoms to surgery was 51.5 § 31.8 h. Patients with strangulated hernia were followed with IAP measurements for 48 h, while patients with incarcerated hernia had IAP measurements 15 min prior to surgical intervention and 15 min after closure of the skin. The Ethics Committee of our institution authorized the study; the procedures were reviewed and supervised by our Institutional Infections Committee. All conscious patients signed an informed consent for the serial measurement of IAP with consecutive blood sampling; a close relative of unconscious patients provided signed consent. Measurement of IAP Intra-abdominal pressure was measured in all patients 15 min before the operation, and 15 min after closure of the skin. In 29 (91%) patients with strangulated hernia, IAP was also measured at 24 h, and, in 27 (84%) patients at 48 h. Three patients (4%) died during the Wrst 6–12 h after the operation and two patients (2.5%) died during the 24– 48 h period after surgery; all were patients with strangulated hernia. IAP in patients with incarcerated hernia was not measured at 24 h or 48 h because, in most of them (44 patients, 90%), the Foley catheter was retrieved 6 h after the operation. In this group there was no mortality. To measure IAP, we used the intra-vesicular pressure measurement method described by Kron et al. [18] and standardized by an international conference of experts of intra-abdominal hypertension and abdominal compartment syndrome [19, 20]. Sterile saline (25 ml) was injected into the empty urinary bladder through a Foley catheter, and the tubing of the drainage bag was cross-clamped just distal to the
123
We used the classiWcation proposed by the international conference of experts of intra-abdominal hypertension and abdominal compartment syndrome [19, 20], considering normal IAP as ranging from 5 to 7 mm Hg in critically ill adults, and raised if 12 mm Hg or higher (Table 1). ACS was diagnosed based on a sustained IAP >20 mm Hg, and clinical and laboratory parameters [19–25]. Clinical parameters included a distended and tender abdomen with signs of IO and shock, and urinary output <50 ml/h. Laboratory parameters included base deWcit >6 mEq/l and arterial blood pH <7.3. Urinary output together with base deWcit and arterial pH were measured simultaneously with IAP. Statistics Continuous variables were reported as mean or median and standard deviation (SD); the analysis was performed using Student’s t test. Categorical variables were reported as percentages and analyzed with analysis of variance (ANOVA) test. Statistical signiWcance was established at P < 0.05. In order to Wnd correlations between mortality, clinical evolution, and body mass index (BMI) with IAP, we performed the paired samples correlations test of Pearson (signiWcant at P < 0.01). Data was processed with the statistical software SPSS version 11.0 (Chicago, IL).
Results There was no diVerence in BMI between patients with strangulated or incarcerated hernia (Table 2). Fifteen minutes preoperative IAP was signiWcantly (P = 0.002) higher in patients with strangulated hernia (mean 37 § 5 mm Hg) Table 1 Intra-abdominal pressure (IAP) classiWcation [19, 20] Critically ill patients
mm Hg
Normal intra-abdominal pressure
5–7
Intra-abdominal hypertension
>12
Grade I
12–15
Grade II
16–20
Grade III
21–25
Grade IV
>25
Hernia (2008) 12:613–620
615
Table 2 Demographics and general characteristics. SD Standard deviation, BMI body mass index
Complicated hernias
Strangulated
Incarcerated
Total
P
n = 32 (39%)
n = 49 (61%)
n = 81 (100%)
Female
14 (44)
27 (55)
41 (51)
NSa
Male
18 (56)
22 (45)
40 (49)
NSa
Age (years) (median § SD)
67 § 15.7
60 § 6.5
62 § 16
0.038b
Clinical evolution (h) (mean § SD)
46.8 § 21
57 § 40.7
51.5 § 31.8
0.313b
27 § 3.7
28.4 § 10.5
27.7 § 7.5
0.647b
Gender
a
Analysis of variance (ANOVA) test b Student’s t test
2
BMI (kg/m ) (mean § SD)
Table 3 Intra-abdominal pressure (IAP) Complicated hernias
Preoperative (15 min)
Postoperative (15 min)
Strangulated (IAP in mm Hg)
37 § 5*
13.8 § 6.4**
<0.0001
Incarcerated (IAP in mm Hg)
24.3 § 6.7*
13 § 3**
<0.0001
Total (IAP in mm Hg)
28.5 § 7.4
13.5 § 5
P***
<0.0001
Values are mean § SD * Student’s t test: preoperative (15 min) IAP in strangulated hernia versus incarcerated hernia P = 0.002 ** Student’s t test: postoperative (15 min) IAP in strangulated hernia versus incarcerated hernia P = 0.836 *** Student’s t test: preoperative (15 min) IAP versus postoperative (15 min) IAP
45 40 37 35
Pressure mm Hg
compared to patients with incarcerated hernia (mean 24.3 § 6.7 mm Hg), 15 min postoperative IAP in both groups decreased to similar values (Table 3). IAP was measured during the preoperative period in patients with strangulated hernia at 15 min, and during the postoperative period at 15 min (13.8 § 6.4 mm Hg), 24 h (9.8 § 3.2 mm Hg) and 48 h (7.4 § 2.4 mm Hg). Postoperative IAP decreased rapidly and at 48 h was normal in all patients (Fig. 1). Preoperative IAP was over 20 mm Hg in 17 patients (53%) with strangulated hernias and in 6 patients (12%) with incarcerated hernias (P = 0.016). IAP normalized rapidly during the postoperative period but remained over 12 mm Hg in one patient (3%) with strangulated hernia and seven patients (14%) with incarcerated hernias. Postoperative IAP at 24 h and 48 h in patients with strangulated hernias was normal (Table 4). Besides physical examination, ACS was deWned by four speciWc parameters: IAP >20 mm Hg, urinary output <50 ml/h, base deWcit >6 mEq/l and arterial blood pH <7.3. According to these parameters, the physiopathologic consequences of ACS developed in 15 patients (47%) with strangulated hernia, leading to a mortality of 5 patients (15%). Table 5 lists the evolution of these parameters 15 min after closure of the skin; at 24 h some parameters remained altered, and at 48 h all parameters were normal for all surviving patients.
30 25 20 13,8
15
9,8 10 7,4 5 0
IAP
Preoperative Postoperative Postoperative Postoperative 15 min 15 min 24 h 48 h 37
13,8
9,8
7,4
Period of measurement Fig. 1 Intra-abdominal pressure (IAP) in patients with strangulated hernia
The most frequent complicated hernia was inguinal hernia, followed by femoral, incisional and umbilical hernia. About 9 of 22 (41%) patients with strangulated inguinal hernia, and 4 of 35 (11%) patients with incarcerated inguinal hernia required a midline laparotomy to resolve the obstruction. All patients with strangulated hernia underwent intestinal resection, while only nine (18%) patients with incarcerated hernia had the obstructed intestinal segment resected. The cause of resection in patients with strangulated hernia was necrosis or gangrene of the involved intestinal segment. In patients with incarcerated hernia, the cause of resection was the impossibility of reducing the obstructed segment of the bowel into the abdominal cavity in seven cases (78%), and doubt regarding the viability of the intestine involved in two cases (22%). Primary anastomosis was performed in 33 (41%) patients, 24 (75%) patients with strangulated hernia and all patients with incarcerated hernia. Eight patients, all with strangulated hernia, had a colostomy or ileostomy constructed. In 27 (84%) patients with strangulated hernia, and all patients with
123
616
Hernia (2008) 12:613–620
Table 4 Values of IAP at diVerent times during the pre and postoperative period Condition
IAP <12 mmHg
12–20 mmHg
>20 mmHg
n (%)
n (%)
n (%)
4 (12.5)*
11 (35.5)
17 (53)
15 min
31 (97)
1 (3)
–
24 h (n = 29–100%)
29 (100)
–
–
48 h (n = 27–100%)
27 (100)
–
–
15 (31)
6 (12)
Strangulated hernia [n = 32 (100%)] Preoperative 15 min Postoperative
Incarcerated hernia [n = 49 (100%)] Preoperative 15 min
28 (57)*
Postoperative 15 min
42 (86)
7 (14)
–
24 h
–
–
–
48 h
–
–
–
32 (39)
26 (32)
23 (28)
Total [n = 81 (100%)] Preoperative 15 min Postoperative 15 min
73 (90)
8 (10)
–
24 h [n = 29 (100%)]
29 (100)
–
–
48 h [n = 27 (100%)]
27 (100)
–
–
* ANOVA P < 0.05 preoperative (15 min) IAP >20 mmHg strangulated hernia vs incarcerated hernia
incarcerated hernia, we closed the abdominal wall primarily. In 10 (67%) of 15 patients who developed ACS and were primarily closed after surgery, 8 (80%) required a colostomy or ileostomy. Five (16%) patients with strangulated hernia and ACS were laparostomized, and two (12.5%) died within the next few hours. The mortality of patients with strangulated hernias was 15% (Table 6), all deceased patients developed ACS and MODS. Patients with strangulated hernia had a worse abdominal condition compared to patients with incarcerated hernia, as reXected by the increased preoperative IAP (37 vs 24.3 mm Hg, P = 0.002), with more patients with IAP higher than 20 mm Hg (53 vs 12%, P < 0.05), higher incidence of ACS (47 vs 0%, P < 0.05), higher incidence of laparostomy (22 vs 0%) and higher mortality rate (15 vs 0%). According to Pearson's paired samples correlation test, patients with strangulated hernia had a <48 h mortality associated to increased postoperative (24 h and 48 h) intra-abdominal pressure (P = <0.0001 and 0.001). Mortality after 48 h was associated with increased 15 min preoperative IAP (P < 0.0001) and a higher BMI (P < 0.0001). Thus, BMI inXuenced 15 min preoperative IAP (P = 0.007) (Table 7).
123
On all patients the hernia was primarily repaired. Of the 22 patients with strangulated inguinal hernia, 19 (86%) were repaired with Lichtenstein hernioplasty; the other 3 (14%) were repaired with Bassini suture repair. A total of 32 patients (91%) with inguinal incarcerated hernia were also repaired with Lichtenstein hernioplasty and 3 (7%) with the Bassini or Shouldice technique. All patients with strangulated femoral hernia required intestinal resection, and six (86%) of seven patients were repaired with the preperitoneal Nyhus technique; the other patient received an anterior repair with a mesh-plug. Two (33%) of six patients with incarcerated femoral hernia had intestinal resection, Wve (83%) were repaired with a preperitoneal or anterior suture repair and one (17%) patient with a mesh-plug anterior repair. There was one patient with a strangulated umbilical hernia; he required intestinal resection and was repaired using Mayo-herniorrhaphy. Of three patients with incarcerated umbilical hernia, one (33%) had intestinal resection; all were repaired with the Mayo-herniorrhaphy technique. Two patients presented with strangulated incisional hernia, one was repaired with Mayo-herniorrhaphy; the other patient was repaired with the onlay mesh technique. Of Wve patients with incarcerated incisional hernia, one (20%) had intestinal resection, three (60%) were repaired with Mayo-herniorrhaphy and two (40%) received an onlay mesh repair (Table 8).
Discussion Hernias are a common cause of IO [12–14]. In this study, strangulated hernia accounted for 39% patients with IO secondary to complicated hernias. As previously reported [16, 17, 25–29], most of these patients were older than 65 years of age. We identiWed two parameters that inXuenced the development of ACS related to strangulated hernia and consequent mortality not previously identiWed as such in other studies: the time of clinical evolution—from the onset of symptoms to surgery—and BMI. Time of clinical evolution had been previously identiWed as a risk factor for intestinal resection in patients with IO with more than 6 h of clinical evolution after the onset of symptoms [16], and was also identiWed as a risk factor for strangulation of complicated hernia and associated mortality [29]; however, it had not previously been linked to ACS in patients with intestinal ischemia secondary to strangulated hernia. BMI is a known factor for development of ACS [21, 22] and postoperative incisional hernia [22], but its importance in strangulated hernia and ACS requiring intestinal resection has not been previously reported. Nevertheless, it should be emphasized that, in an individual patient, the eVects of increased IAP are not isolated but may be superimposed on multiple coexistent factors [1], of which BMI and the time
Hernia (2008) 12:613–620
617
Table 5 Abdominal compartment syndrome (ACS) according to diagnosis and time of IAP measurement Condition
IAP >20 mmHg
Urinary output <50 ml/h
Base deWcit >6 mEq/l
Arterial pH <7.3
ACS
n (%)
n (%)
n (%)
n (%)
n (%)
17 (53)
28 (87.5)
19 (59)
16 (50)
15 (47)*
15 min
–
11 (34)
24 (75)
19 (59)
–
24 h
–
3 (9)
4 (12.5)
2 (6)
–
48 h
–
–
–
–
–
6 (12)
4 (8)
5 (10)
1 (2)
–
15 min
–
1 (2)
12 (24.5)
–
–
24 h
–
–
–
–
–
48 h
–
–
–
–
–
23 (28)
32 (39.5)
24 (30)
17 (21)
15 (18.5)*
–
12 (15)
36 (44)
19 (23)
–
24 h
–
3 (4)
4 (5)
2 (2.5)
–
48 h
–
–
–
–
–
Strangulated hernia [n = 32 (100%)] Preoperative 15 min Postoperative
Incarcerated hernia [n = 49 (100%)] Preoperative 15 min Postoperative
Total [n = 81 (100%)] Preoperative 15 min Postoperative 15 min
* ANOVA P < 0.05 ACS in patients with strangulated vs incarcerated hernia
Table 6 Causes of strangulated and incarcerated hernia: management and mortality Type of hernia
Strangulated hernia n = 32 (100%)
Incarcerated hernia n = 49 (100%) Incisional n = 2 (6)
Inguinal n = 35 (72)
Femoral n = 6 (12)
Umbilical n = 3 (6)
Incisional n = 5 (10)
Total n = 81 (100%)
Inguinal n = 22 (69)
Femoral n = 7 (22)
Umbilical n = 1 (3)
Intestinal resection*
22 (100)
7 (100)
1 (100)
2 (100)
5 (14)
2 (33)
1 (33)
1 (20)
Primary anastomosis
16 (73)
5 (71)
1 (100)
2 (100)
5 (14)
2 (33)
1 (33)
1 (20)
33 (41)
Ostomy**
6 (27)
2 (29)
–
–
–
–
–
–
8 (10)
Abdominal wall primary closure***
20 (91)
4 (57)
1 (100)
2 (100)
35 (100)
6 (100)
3 (100)
5 (100)
76 (94)
Laparostomy
2 (9)
3 (43)
–
–
–
–
–
–
5 (6)
41 (51)
Mortality <48 h
1 (4.5)
2 (28.5)
–
–
–
–
–
–
3 (4)
>48 h
1 (4.5)
1 (14)
–
–
–
–
–
–
2 (2.5)
* ANOVA P < 0.05 intestinal resection in patients with strangulated versus incarcerated hernia ** ANOVA P < 0.05 ostomy in patients with strangulated versus incarcerated hernia *** ANOVA P < 0.05 abdominal wall primary closure in patients with incarcerated hernia versus strangulated hernia
of clinical evolution from the onset of symptoms to surgery are only two. Controversial results regarding the period of time required to develop strangulation in patients with complicated hernia have been reported. Some authors have
proposed that the duration of symptoms prior to surgical intervention was not predictive of gangrene [30], while others proposed that the duration of symptoms from the onset to hospitalization and surgery were related to the development of strangulation [16, 29]. The results of this study
123
618
Hernia (2008) 12:613–620
Table 7 Paired samples correlation test of Pearson in 32 patients with strangulated hernia Clinical evolution (h)
BMI
Preoperative 15 min IAP
Postoperative 15 min IAP
24 h IAP
48 h IAP
<48 h mortality
>48 h mortality
Clinical evolution (h)
–
0.984
0.063
0.285
0.309
0.512
0.032
0.041
BMI
0.984
–
0.007*
0.028
0.074
0.086
0.027
<0.0001*
Preoperative 15 min IAP
0.063
0.007*
–
0.768
0.995
0.562
0.754
<0.0001*
Postoperative 15 min IAP
0.285
0.028
0.768
–
0.743
0.791
<0.0001*
0.944
24 h IAP
0.309
0.074
0.995
0.743
–
0.041
0.0001*
0.045
48 h IAP
0.512
0.086
0.562
0.791
0.041
–
0.001*
0.027
<48 h mortality
0.032
0.027
0.754
<0.0001*
0.0001*
0.001*
–
0.993
>48 h mortality
0.041
<0.0001*
<0.0001*
0.944
0.045
0.027
0.993
–
* P signiWcant at <0.01
Table 8 Type of repair Type of hernia
Strangulated hernia n = 32 (100%)
Incarcerated hernia n = 49 (100%)
Inguinal n = 22
Femoral n=7
Umbilical n=1
Incisional n=2
Inguinal n = 35
Suture repair
3 (14)
6 (86)
1 (100)
1 (50)
3 (8.5)
5 (83)
3 (100)
3 (60)
25 (31)
Mesh repair
19 (86)
1 (14)
–
1 (50)
32 (91.5)
1 (17)
–
2 (40)
56 (69)
show that the duration of clinical evolution from the onset of symptoms to surgery is not predictive of strangulation. Although the analysis was not signiWcant (P = 0.313), this Wnding supports the notion that an incarcerated segment of bowel may become gangrenous in as little as 5 h or less, or it may not progress to gangrene in as much as 120 h [30]. Preoperative IAP in patients with strangulated hernia was signiWcantly higher compared with preoperative IAP in patients with incarcerated hernia; however, patients with incarcerated hernia had a longer clinical evolution than patients with strangulated hernia. This fact suggests that the development of strangulation is a pathophysiological event not directly related to incarceration of an abdominal hernia, and that other factors must be conditioning the development of strangulation. Based on these results, we believe that an increased IAP in patients presenting complicated hernia may be a factor for predicting strangulation. Immediate postoperative IAP decreased rapidly in all patients, and was normal at 48 h. However, decreased IAP did not diminish the likelihood of development of ACS because metabolic and hemodynamic alterations had developed and were present before the surgical intervention. Even though the cause of ACS was resolved, the cascade of physiopathologic events unchained by the initial insult was irreversible. The Wrst physiologic alteration of IAP is a marked impairment of renal function [1, 6, 18], followed by cardiovascular and hemodynamic eVects [3, 4, 6, 18]. Although surgical abdominal decompression decreases IAP rapidly and improves renal, cardiovascular and hemodynamic function
123
Femoral n=6
Umbilical n=3
Incisional n=5
Total n = 81 (100%)
[3, 18, 31–33], the severity of the increased IAP, its physiopathologic consequences [1, 3, 4, 6, 23], and the consequent development of ACS depend on the duration and cause of IAP. Intestinal resection was performed in all patients with strangulated hernia. Some patients with incarcerated hernia also had an intestinal resection with primary anastomosis and an uneventful postoperative recovery without mortality. Of the 10 of 15 patients (67%) who developed ACS and were primarily closed after surgery, 8 (80%) required a colostomy or ileostomy due to septic abdominal conditions. Most patients who preoperatively developed ACS were closed primarily because, in those cases, we felt that the abdominal cavity was clean and we thought that a second look operation was unnecessary. In addition, surgery allowed the resolution of the intestinal obstruction causing ACS and the abdominal wall permitted the tension-free closure of the fascia. At our institution we repair most complicated inguinal hernias with Lichtenstein hernioplasty [17, 28]. This repair has been proven eVective and safe [17, 28, 34–37]. In this series, 66% of the patients with strangulated inguinal hernia and 71.5% of the patients with incarcerated inguinal hernia were repaired with this procedure and had only minor morbidity. However, other types of complicated hernia were repaired mostly with suture techniques. Only two femoral hernias (one strangulated and one incarcerated) were repaired with prosthesis, as well as three of seven incisional hernias (43%). The prosthetic repair of complicated hernias has been proven safe in inguinal hernia
Hernia (2008) 12:613–620
[17, 28, 37] and other types of hernia [37–39]; the main contraindications are the presence of necrosis or peritonitis [17, 28, 37–39]. Prosthetic repair has been studied mostly in complicated inguinal and incisional hernia. Very few studies have dealt with strangulated or incarcerated umbilical and femoral hernias; it is possible that the outcomes of prosthetic repair in these hernias would be similar to the outcomes of inguinal or incisional hernia; however, in this study the main reason for suture repair was the local septic conditions or the surgeon’s preference at the time of surgery.
Conclusions The results of this work evidence, through the measurement of IAP, the clinical severity of strangulated hernia. Measurement of IAP may be used as a predictor of intestinal strangulation in patients presenting acute abdominal compartment syndrome secondary to complicated hernia. Acknowledgments The authors would like to thank M.A. Contreras, M.D., for his helpful advice in the preparation of this manuscript.
References 1. Schein M, Wittmann DH, Aprahamian CC, Condon RE (1995) The abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure. J Am Coll Surg 180:745–753 2. Burch JM, Moore EE, Moore FA, Franciose R (1996) The abdominal compartment syndrome. Surg Clin North Am 76:833–842 3. Saggi BH, Sugerman HJ, Ivatury RR, BloomWeld GL (1998) Abdominal compartment syndrome. J Trauma 45:597–608 4. Sieh KM, Chu KM, Wong J (2001) Intra-abdominal hypertension and abdominal compartment syndrome. Langenbecks Arch Surg 386:53–61 5. Peralta R, Hojman H (2001) Abdominal compartment syndrome. Int Anesthesiol Clin 39:75–94 6. Hong JJ, Cohn SM, Perez JM, Dolich MO, Brown M, McKenney MG (2002) Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 89:591–596 7. Bongard F, Pianim N, Dubecz S, Klein SR (1995) Adverse consequences on increased intra-abdominal pressure on bowel tissue oxygen. J Trauma 39:519–524 8. Fevang BT, Fevang J, Stangeland L, Soreide O, Svanes K, Viste A (2000) Complications and death after surgical treatment of small bowel obstruction: a 35-year institutional experience. Ann Surg 231:529–537 9. Arnell T, Stamos MJ (2001) Small bowel obstruction. Clin Colon Rectal Surg 14:69–78 10. Franklin ME, Gonzales JJ, Miter DB, Glass JL, Paulson D (2004) Laparoscopic diagnosis and treatment of intestinal obstruction. Surg Endosc 18:26–30 11. Fevang BT, Fevang J, Lie SA, Soreide O, Svanes K, Viste A (2004) Long-term prognosis after operation for adhesive small bowel obstruction. Ann Surg 240:193–201
619 12. Foster NM, McGory ML, Zingmond DS, Ko CY (2006) Small bowel obstruction: a population-based appraisal. J Am Coll Surg 203:170–176 13. Ihedioha U, Alani A, Modak P, Chong P, O’Dwyer PJ (2006) Hernias are the most common cause of strangulation in patients presenting with small bowel obstruction. Hernia 10:338–340 14. Beltrán MA, Cruces KS (2007) Primary tumors of Jejunum and Ileum as a cause of intestinal obstruction: a case control study. Int J Surg 5:183–191 15. Munegato G, Grigoletto R, Brandolese R (2000) Respiratory mechanics in abdominal compartment syndrome and large incisional hernias of the abdominal wall. Hernia 4:282–285 16. Kurt N, Oncel M, Ozkan Z, Bingul S (2003) Risk and outcome of bowel resection in patients with incarcerated groin hernias: retrospective study. World J Surg 27:741–743 17. Beltrán MA, Cruces KS (2007) Are the outcomes of emergency Lichtenstein hernioplasty similar to the outcomes of elective Lichtenstein hernioplasty? Int J Surg 5:198–204 18. Kron IL, Harman PK, Nolan SP (1984) The measurement of intraabdominal pressure as a criterion for abdominal re-exploration. Ann Surg 199:28–30 19. Malbrain MLNG, Cheatham ML, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppäniemi A, Olvera C, Ivatury R, D’Amours S, Wendon J, Hillman K, Johansson K, Kolkman K, Wilmer A (2006) Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome: I. DeWnitions. Intensive Care Med 32:1722–1732 20. Cheatham ML, Malbrain MLNG, Kirkpatrick A, Sugrue M, Parr M, De Waele J, Balogh Z, Leppäniemi A, Olvera C, Ivatury R, D’Amours S, Wendon J, Hillman K, Wilmer A (2007) Results from the international conference of experts on intra-abdominal hypertension and abdominal compartment syndrome: II. Recommendations. Intensive Care Med 33:951–962 21. Sanchez NC, Tenofsky PL, Dort JM, Shen LY, Helmer SD, Smith RS (2001) What is normal intra-abdominal pressure? Am Surg 67:243–248 22. Cobb WS, Burns JM, Kercher KW, Matthews BD, Norton JH, Heniford TB (2005) Normal intraabdominal pressure in healthy adults. J Surg Res 129:231–235 23. Meldrum DR, Moore FA, Moore EE, Franciose RJ, Sauaia A, Burch JM (1997) Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg 174:667–673 24. Ivatury RR, Diebel L, Porter JM, Simon RJ (1997) Intra-abdominal hypertension and the abdominal compartment syndrome. Surg Clin North Am 77:783–812 25. Sugrue M, Bauman A, Jones F, Bishop G, Flabouris A, Parr M, Stewart A, Hillman K, Deane SA (2002) Clinical examination is an inaccurate predictor of intraabdominal pressure. World J Surg 26:1428–1431 26. Alvarez JA, Baldonedo RF, Bear IG, Solis JA, Álvarez P, Jorge JI (2004) Incarcerated groin hernias in adults: presentation and outcome. Hernia 8:121–126 27. Rodríguez-Paz CA, Palacio-Vélez F (2000) Causas y mortalidad de la obstrucción intestinal en el anciano. Rev Gastroenterol Mex 65:121–123 28. Beltrán MA, Cruces KS, Tapia TFQ, Vicencio A (2006) Resultados quirúrgicos de la hernioplastía de Lichtenstein de urgencia. Rev Chil Cir 58:359–364 29. Hjaltason E (1981) Incarcerated hernia. Acta Chir Scand 147:263– 267 30. Golub R, Cantu R (1998) Incarcerated anterior abdominal wall hernias in a community hospital. Hernia 2:157–161 31. Schachtrupp A, Höer J, Töns C, Klinge U, Reckord U, Schumpelick V (2002) Intra-abdominal pressure: a reliable criterion for laparostomy. Hernia 6:102–107
123
620 32. Schachtrupp A, Jansen M, Bertram P, Kuhlen R, Schumpelick V (2006) Abdominal compartment syndrome: signiWcance, diagnosis and treatment. Anaesthesist 55:660–667 33. Bertram P, Schachtrupp A, Rosch R, Schumacher O, Schumpelick V (2006) Abdominal compartment syndrome. Chirurg 77:573– 579 34. Wysocki A, Kulawik J, Pozniczek M, Srtzalka M (2006) Is the Lichtenstein operation of strangulated hernia a safe procedure? World J Surg 30:1065–1070 35. Lohsiriwat V, Sridermma W, Akaraviputh T, Boonnuch W, Chinsawangwatthanakol V, Methasate A, Lert-Akyamanee N, Lohsiriwat D (2007) Surgical outcomes of Lichtenstein tension-free hernioplasty for acutely incarcerated inguinal hernia. Surg Today 37:212–214
123
Hernia (2008) 12:613–620 36. Bessa SS, Katri KM, Abdel-Salam WN, Abdel-Baki NA (2007) Early results from the use of the Lichtenstein repair in the management of strangulated groin hernia. Hernia 11:239–242 37. Campanelli G, Nicolosi FM, Pettinari D, Avesani EC (2004) Prosthetic repair, intestinal resection, and potentially contaminated areas: safe and feasible? Hernia 8:190–192 38. Abdel-Baki NA, Bessa SS, Abdel-Razek AH (2007) Comparison of prosthetic mesh repair and tissue repair in the emergency management of incarcerated para-umbilical hernia: a prospective randomized study. Hernia 11:163–167 39. Wysocki A, Pozniczek M, Krzywon J, Bolt L (2001) Use of polypropylene prostheses for strangulated inguinal and incisional hernias. Hernia 5:105–106
