Identification of the Pattern of Changes in Intra-Pressure in Patients with Diseases of the Organs of the Abdominal Cavity

The cause of increasing intra-abdominal pressure (WBD) can be a variety of diseases and pathological conditions in the abdominal cavity and retroperitoneal space. When the pressure in the abdominal cavity rises to a level interrupting the normal blood supply of the internal organs, the so-called intra-abdominal hypertension syndrome (SI-AG) develops, which is manifested by the growing signs of multi-organ failure.

The material of the study was 6 groups of patients with various acute surgical diseases of the abdominal cavity. The control group consisted of patients who did not have acute surgical pathology. The level of WBD and its dynamics was assessed by measuring the pressure in the human bladder.

In the control group of observations (n = 15, men - 53%, women - 47%), mean values of WBD were 2.4 ± 0.4 cm aq. Art.

The mean value of WBD in patients with acute cholecystitis (Group I, n = 25, 17 - operated, 8 - treated conservatively) at admission was 5.8 ± 0.6 cm aq. Art. In non-operated patients for 7-8 days, the level of WBD did not differ from those in the control group. At the operated patients in the early postoperative period the expressed tendency to the raised parameters of WBD was defined.

The level of WBD in patients with acute pancreatitis (group II n = 25) varied depending on the severity of the disease. Thus, in 11 patients with mild form, and in 5 patients with moderate severity, the values of VBD remained practically within the norm (6.8 ± 1.1 cm of water). In 3 non-operated patients with severe acute pancreatitis, the first degree of intra-abdominal hypertension (MSH) was observed (17.6 ± 0.5 cm H2O). In 2 patients who were operated for fermentative peritonitis, the II degree of VPG was registered before the operation. After surgery, WBD gradually decreased. In 4 patients with established pancreatic necrosis, there was also a similar dynamics of WBD, and 1 of them had clear signs of the SIAG, which only passed after the performed operation.

The level of WBD in patients with intestinal obstruction (III group n = 25) changed as follows: before the operation, in 6 patients the parameters of WBD remained within the norm, in 14 - observed I degree, in 5 - II degree of VPG. In this case, patients with a higher level of VBD had a clear radiologic picture of intestinal obstruction. After the operation, the indicators of WBD came to normal values.

In 6 patients with impaired hernia (group IV, n = 8), but without necrosis of the gut, in the pre- and postoperative period, VBD remained within the normal range. In 1 patient with necrosis of the loop of the intestine before the operation, I degree IAB was registered. In 1 patient, the WBD increased after spontaneous repositioning of the ventral hernia.

V of 9 patients with acute diffuse peritonitis of different genesis, in the pre- and postoperative period the level of WBD was approaching normal values (7.8 ± 1.5 cm H2O). In 4 patients before the operation there was a first degree (15 ± 0.7 cm of water), in 2 - grade IIB. In 1 patient with signs of peritonitis persisting in the postoperative period, MSH increased to grade III, with clear signs of development of the SIAG. After performed relaparotomy, WBD decreased slightly, cardiopulmonary and renal failure persisted.

Group VI consisted of 2 patients with thrombosis of the mesenteric arteries.

One of them was diagnosed with the first degree of MSH, which was resolved only after the operation. The second patient before the operation had a second degree of MSH, which was not only preserved in the postoperative period, but also increased with the development of a clear clinical picture of the SIAG. The level of WBD decreased only after relaparotomy, with a corresponding normalization of the functions of internal organs.

Thus, urgent surgical diseases can cause an increase in WBD, up to the development of the SIAG. This requires careful alertness and control, relative development of this complication, from the attending physicians and on-duty surgeons.