Intra abdominal pressure (IAP) is defined as the pressure in the peritoneal cavity and an acute rise in this pressure can result in adverse physiological consequences termed Abdominal Compartment Syndrome (ACS). This increase in abdominal pressure can affect multiple organ systems and once a certain stage has been passed, the effects are no longer reversible by decompression. So challenge is to be aware of the condition and act sufficiently early to reverse the effects.
Aims: 1) To assess whether intra abdominal pressure is an independent predictor of morbidity and mortality for patients undergoing emergency exploratory laparotomy. 2) To identify the hidden causes of abdominal compartment syndrome.
Settings and Design : this was a randomised controlled trial involving 50 patients, who were admitted and
underwent emergency laparotomy.
Methods and Material:50 patients who underwent emergency laparotomy due to various indications ,were included in the study. Intra abdominal pressure was measured through urinary bladder with Foley’s catheter, which was connected to saline manometer. Readings were taken preoperatively and then post operatively at 0, 6, 24 and 72 hours. Grading of intra abdominal hypertension (IAH) was done as per the pressure. ACS was labelled if IAH was associated with at least one newly developed organ system dysfunction.
Results: Pre operative IAH was seen in 62% of the patients. Raised IAP at 6 hours and 24 hours is significant predictor of morbidity (p =0.031 and p = 0.004 respectively) whereas, raised IAP at 48 hours is a significant predictor of mortality. Similarly, raised IAP at 6 hours is also a significant predictor for longer hospital stay (p=0.031).
Conclusions : IAP is a significant indicator of morbidity and mortality in the patients undergoing emergency laparotomy. Thus a thorough monitoring and early decompression can decrease the morbidity and mortality rate.