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Abdominal compartment syndrome in adults

Mark Gestring, MD
Section Editors
Hilary Sanfey, MD
Eileen M Bulger, MD, FACS
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Abdominal compartment syndrome refers to organ dysfunction caused by intra-abdominal hypertension. It may be under-recognized because it primarily affects patients who are already quite ill and whose organ dysfunction may be incorrectly ascribed to progression of the primary illness. Since treatment can improve organ dysfunction, it is important that the diagnosis be considered in the appropriate clinical situation. The definition, incidence, risk factors, clinical presentation, diagnosis, management, and prognosis of intra-abdominal hypertension and abdominal compartment syndrome are reviewed here.

The management of the open abdomen following abdominal decompression is discussed separately. (See "Management of the open abdomen in adults".)


Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are distinct clinical entities and should not be used interchangeably.

Intra-abdominal pressure — Intra-abdominal pressure (IAP) is the steady state pressure concealed within the abdominal cavity [1]. For most critically ill patients, an IAP of 5 to 7 mmHg is considered normal. In a prospective cohort study of 77 supine hospitalized patients, the IAP averaged 6.5 mmHg and was directly related to body mass index [2].

The normal range described above is not applicable for all patients. Patients with increased abdominal girth that developed slowly may have higher baseline intra-abdominal pressures. As an example, morbidly obese and pregnant individuals can have chronically elevated intra-abdominal pressure (as high as 10 to 15 mmHg) without adverse sequelae [1].

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Literature review current through: Sep 2017. | This topic last updated: Feb 06, 2017.
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  1. Malbrain ML, Cheatham ML, Kirkpatrick A, et al. Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions. Intensive Care Med 2006; 32:1722.
  2. Sanchez NC, Tenofsky PL, Dort JM, et al. What is normal intra-abdominal pressure? Am Surg 2001; 67:243.
  3. Diebel LN, Dulchavsky SA, Wilson RF. Effect of increased intra-abdominal pressure on mesenteric arterial and intestinal mucosal blood flow. J Trauma 1992; 33:45.
  4. Schein M, Ivatury R. Intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 1998; 85:1027.
  5. Ivatury RR, Diebel L, Porter JM, Simon RJ. Intra-abdominal hypertension and the abdominal compartment syndrome. Surg Clin North Am 1997; 77:783.
  6. Caldwell CB, Ricotta JJ. Changes in visceral blood flow with elevated intraabdominal pressure. J Surg Res 1987; 43:14.
  7. Vidal MG, Ruiz Weisser J, Gonzalez F, et al. Incidence and clinical effects of intra-abdominal hypertension in critically ill patients. Crit Care Med 2008; 36:1823.
  8. http://www.wsacs.org/consensus_summary.php (Accessed on October 11, 2011).
  9. van Mook WN, Huslewe-Evers RP, Ramsay G. Abdominal compartment syndrome. Lancet 2002; 360:1502.
  10. Wilson A, Longhi J, Goldman C, McNatt S. Intra-abdominal pressure and the morbidly obese patients: the effect of body mass index. J Trauma 2010; 69:78.
  11. Sugrue M. Abdominal compartment syndrome. Curr Opin Crit Care 2005; 11:333.
  12. Bailey J, Shapiro MJ. Abdominal compartment syndrome. Crit Care 2000; 4:23.
  13. Malbrain ML, Deeren D, De Potter TJ. Intra-abdominal hypertension in the critically ill: it is time to pay attention. Curr Opin Crit Care 2005; 11:156.
  14. Malbrain ML, Chiumello D, Pelosi P, et al. Incidence and prognosis of intraabdominal hypertension in a mixed population of critically ill patients: a multiple-center epidemiological study. Crit Care Med 2005; 33:315.
  15. Cheatham ML, White MW, Sagraves SG, et al. Abdominal perfusion pressure: a superior parameter in the assessment of intra-abdominal hypertension. J Trauma 2000; 49:621.
  16. Moore AF, Hargest R, Martin M, Delicata RJ. Intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 2004; 91:1102.
  17. Sugerman HJ, DeMaria EJ, Felton WL 3rd, et al. Increased intra-abdominal pressure and cardiac filling pressures in obesity-associated pseudotumor cerebri. Neurology 1997; 49:507.
  18. Malbrain ML, Chiumello D, Pelosi P, et al. Prevalence of intra-abdominal hypertension in critically ill patients: a multicentre epidemiological study. Intensive Care Med 2004; 30:822.
  19. Hong JJ, Cohn SM, Perez JM, et al. Prospective study of the incidence and outcome of intra-abdominal hypertension and the abdominal compartment syndrome. Br J Surg 2002; 89:591.
  20. Balogh Z, McKinley BA, Holcomb JB, et al. Both primary and secondary abdominal compartment syndrome can be predicted early and are harbingers of multiple organ failure. J Trauma 2003; 54:848.
  21. Balogh Z, McKinley BA, Cocanour CS, et al. Secondary abdominal compartment syndrome is an elusive early complication of traumatic shock resuscitation. Am J Surg 2002; 184:538.
  22. Balogh Z, McKinley BA, Cocanour CS, et al. Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome. Arch Surg 2003; 138:637.
  23. Ertel W, Oberholzer A, Platz A, et al. Incidence and clinical pattern of the abdominal compartment syndrome after "damage-control" laparotomy in 311 patients with severe abdominal and/or pelvic trauma. Crit Care Med 2000; 28:1747.
  24. Markell KW, Renz EM, White CE, et al. Abdominal complications after severe burns. J Am Coll Surg 2009; 208:940.
  25. Kirkpatrick AW, Ball CG, Nickerson D, D'Amours SK. Intraabdominal hypertension and the abdominal compartment syndrome in burn patients. World J Surg 2009; 33:1142.
  26. Biancofiore G, Bindi ML, Romanelli AM, et al. Intra-abdominal pressure monitoring in liver transplant recipients: a prospective study. Intensive Care Med 2003; 29:30.
  27. Saggi BH, Sugerman HJ, Ivatury RR, Bloomfield GL. Abdominal compartment syndrome. J Trauma 1998; 45:597.
  28. Morken J, West MA. Abdominal compartment syndrome in the intensive care unit. Curr Opin Crit Care 2001; 7:268.
  29. Karkos CD, Menexes GC, Patelis N, et al. A systematic review and meta-analysis of abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysms. J Vasc Surg 2014; 59:829.
  30. Djavani Gidlund K, Wanhainen A, Björck M. Intra-abdominal hypertension and abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 2011; 41:742.
  31. Mentula P, Hienonen P, Kemppainen E, et al. Surgical decompression for abdominal compartment syndrome in severe acute pancreatitis. Arch Surg 2010; 145:764.
  32. Regueira T, Bruhn A, Hasbun P, et al. Intra-abdominal hypertension: incidence and association with organ dysfunction during early septic shock. J Crit Care 2008; 23:461.
  33. O'Mara MS, Slater H, Goldfarb IW, Caushaj PF. A prospective, randomized evaluation of intra-abdominal pressures with crystalloid and colloid resuscitation in burn patients. J Trauma 2005; 58:1011.
  34. Mao EQ, Tang YQ, Fei J, et al. Fluid therapy for severe acute pancreatitis in acute response stage. Chin Med J (Engl) 2009; 122:169.
  35. Oda J, Yamashita K, Inoue T, et al. Resuscitation fluid volume and abdominal compartment syndrome in patients with major burns. Burns 2006; 32:151.
  36. Coombs, HC. The mechanism of the regulation of intra-abdominal pressure. Am J Physiol 1922; 61:159.
  37. Cullen DJ, Coyle JP, Teplick R, Long MC. Cardiovascular, pulmonary, and renal effects of massively increased intra-abdominal pressure in critically ill patients. Crit Care Med 1989; 17:118.
  38. Richardson JD, Trinkle JK. Hemodynamic and respiratory alterations with increased intra-abdominal pressure. J Surg Res 1976; 20:401.
  39. Barnes GE, Laine GA, Giam PY, et al. Cardiovascular responses to elevation of intra-abdominal hydrostatic pressure. Am J Physiol 1985; 248:R208.
  40. MacDonnell SP, Lalude OA, Davidson AC. The abdominal compartment syndrome: the physiological and clinical consequences of elevated intra-abdominal pressure. J Am Coll Surg 1996; 183:419.
  41. Kashtan J, Green JF, Parsons EQ, Holcroft JW. Hemodynamic effect of increased abdominal pressure. J Surg Res 1981; 30:249.
  42. Ridings PC, Bloomfield GL, Blocher CR, Sugerman HJ. Cardiopulmonary effects of raised intra-abdominal pressure before and after intravascular volume expansion. J Trauma 1995; 39:1071.
  43. Burchard KW, Ciombor DM, McLeod MK, et al. Positive end expiratory pressure with increased intra-abdominal pressure. Surg Gynecol Obstet 1985; 161:313.
  44. Aprahamian C, Wittmann DH, Bergstein JM, Quebbeman EJ. Temporary abdominal closure (TAC) for planned relaparotomy (etappenlavage) in trauma. J Trauma 1990; 30:719.
  45. Obeid F, Saba A, Fath J, et al. Increases in intra-abdominal pressure affect pulmonary compliance. Arch Surg 1995; 130:544.
  46. Quintel M, Pelosi P, Caironi P, et al. An increase of abdominal pressure increases pulmonary edema in oleic acid-induced lung injury. Am J Respir Crit Care Med 2004; 169:534.
  47. Simon RJ, Friedlander MH, Ivatury RR, et al. Hemorrhage lowers the threshold for intra-abdominal hypertension-induced pulmonary dysfunction. J Trauma 1997; 42:398.
  48. Doty JM, Saggi BH, Blocher CR, et al. Effects of increased renal parenchymal pressure on renal function. J Trauma 2000; 48:874.
  49. Doty JM, Saggi BH, Sugerman HJ, et al. Effect of increased renal venous pressure on renal function. J Trauma 1999; 47:1000.
  50. Shenasky JH 2nd. The renal hemodynamic and functional effects of external counterpressure. Surg Gynecol Obstet 1972; 134:253.
  51. Bloomfield GL, Blocher CR, Fakhry IF, et al. Elevated intra-abdominal pressure increases plasma renin activity and aldosterone levels. J Trauma 1997; 42:997.
  52. Richards WO, Scovill W, Shin B, Reed W. Acute renal failure associated with increased intra-abdominal pressure. Ann Surg 1983; 197:183.
  53. Le Roith D, Bark H, Nyska M, Glick SM. The effect of abdominal pressure on plasma antidiuretic hormone levels in the dog. J Surg Res 1982; 32:65.
  54. Smith JH, Merrell RC, Raffin TA. Reversal of postoperative anuria by decompressive celiotomy. Arch Intern Med 1985; 145:553.
  55. Friedlander MH, Simon RJ, Ivatury R, et al. Effect of hemorrhage on superior mesenteric artery flow during increased intra-abdominal pressures. J Trauma 1998; 45:433.
  56. Chang MC, Cheatham ML, Nelson LD, et al. Gastric tonometry supplements information provided by systemic indicators of oxygen transport. J Trauma 1994; 37:488.
  57. Diebel LN, Myers T, Dulchavsky S. Effects of increasing airway pressure and PEEP on the assessment of cardiac preload. J Trauma 1997; 42:585.
  58. Samel ST, Neufang T, Mueller A, et al. A new abdominal cavity chamber to study the impact of increased intra-abdominal pressure on microcirculation of gut mucosa by using video microscopy in rats. Crit Care Med 2002; 30:1854.
  59. Ivatury RR, Porter JM, Simon RJ, et al. Intra-abdominal hypertension after life-threatening penetrating abdominal trauma: prophylaxis, incidence, and clinical relevance to gastric mucosal pH and abdominal compartment syndrome. J Trauma 1998; 44:1016.
  60. Diebel LN, Wilson RF, Dulchavsky SA, Saxe J. Effect of increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J Trauma 1992; 33:279.
  61. Diebel LN, Dulchavsky SA, Brown WJ. Splanchnic ischemia and bacterial translocation in the abdominal compartment syndrome. J Trauma 1997; 43:852.
  62. Gargiulo NJ 3rd, Simon RJ, Leon W, Machiedo GW. Hemorrhage exacerbates bacterial translocation at low levels of intra-abdominal pressure. Arch Surg 1998; 133:1351.
  63. Luca A, Cirera I, García-Pagán JC, et al. Hemodynamic effects of acute changes in intra-abdominal pressure in patients with cirrhosis. Gastroenterology 1993; 104:222.
  64. Nakatani T, Sakamoto Y, Kaneko I, et al. Effects of intra-abdominal hypertension on hepatic energy metabolism in a rabbit model. J Trauma 1998; 44:446.
  65. Luce JM, Huseby JS, Kirk W, Butler J. Mechanism by which positive end-expiratory pressure increases cerebrospinal fluid pressure in dogs. J Appl Physiol Respir Environ Exerc Physiol 1982; 52:231.
  66. Bloomfield GL, Dalton JM, Sugerman HJ, et al. Treatment of increasing intracranial pressure secondary to the acute abdominal compartment syndrome in a patient with combined abdominal and head trauma. J Trauma 1995; 39:1168.
  67. Citerio G, Vascotto E, Villa F, et al. Induced abdominal compartment syndrome increases intracranial pressure in neurotrauma patients: a prospective study. Crit Care Med 2001; 29:1466.
  68. Joseph DK, Dutton RP, Aarabi B, Scalea TM. Decompressive laparotomy to treat intractable intracranial hypertension after traumatic brain injury. J Trauma 2004; 57:687.
  69. Kirkpatrick AW, Brenneman FD, McLean RF, et al. Is clinical examination an accurate indicator of raised intra-abdominal pressure in critically injured patients? Can J Surg 2000; 43:207.
  70. Sugrue M, Bauman A, Jones F, et al. Clinical examination is an inaccurate predictor of intraabdominal pressure. World J Surg 2002; 26:1428.
  71. Pickhardt PJ, Shimony JS, Heiken JP, et al. The abdominal compartment syndrome: CT findings. AJR Am J Roentgenol 1999; 173:575.
  72. Malbrain ML. Is it wise not to think about intraabdominal hypertension in the ICU? Curr Opin Crit Care 2004; 10:132.
  73. Malbrain ML. Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med 2004; 30:357.
  74. Kirkpatrick AW, Roberts DJ, De Waele J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med 2013; 39:1190.
  75. Cheatham ML, De Waele JJ, De Laet I, et al. The impact of body position on intra-abdominal pressure measurement: a multicenter analysis. Crit Care Med 2009; 37:2187.
  76. De Keulenaer BL, De Waele JJ, Powell B, Malbrain ML. What is normal intra-abdominal pressure and how is it affected by positioning, body mass and positive end-expiratory pressure? Intensive Care Med 2009; 35:969.
  77. Iberti TJ, Lieber CE, Benjamin E. Determination of intra-abdominal pressure using a transurethral bladder catheter: clinical validation of the technique. Anesthesiology 1989; 70:47.
  78. Iberti TJ, Kelly KM, Gentili DR, et al. A simple technique to accurately determine intra-abdominal pressure. Crit Care Med 1987; 15:1140.
  79. Fusco MA, Martin RS, Chang MC. Estimation of intra-abdominal pressure by bladder pressure measurement: validity and methodology. J Trauma 2001; 50:297.
  80. Lacey SR, Bruce J, Brooks SP, et al. The relative merits of various methods of indirect measurement of intraabdominal pressure as a guide to closure of abdominal wall defects. J Pediatr Surg 1987; 22:1207.
  81. Sugerman HJ. Effects of increased intra-abdominal pressure in severe obesity. Surg Clin North Am 2001; 81:1063.
  82. Chang MC, Miller PR, D'Agostino R Jr, Meredith JW. Effects of abdominal decompression on cardiopulmonary function and visceral perfusion in patients with intra-abdominal hypertension. J Trauma 1998; 44:440.
  83. Hobson KG, Young KM, Ciraulo A, et al. Release of abdominal compartment syndrome improves survival in patients with burn injury. J Trauma 2002; 53:1129.
  84. Dries DJ. Abdominal compartment syndrome: toward less-invasive management. Chest 2011; 140:1396.
  85. Cheatham ML, Safcsak K. Percutaneous catheter decompression in the treatment of elevated intraabdominal pressure. Chest 2011; 140:1428.
  86. Cheatham ML. Nonoperative management of intraabdominal hypertension and abdominal compartment syndrome. World J Surg 2009; 33:1116.
  87. Cheatham ML. Abdominal compartment syndrome. Curr Opin Crit Care 2009; 15:154.
  88. Smith PK, Tyson GS Jr, Hammon JW Jr, et al. Cardiovascular effects of ventilation with positive expiratory airway pressure. Ann Surg 1982; 195:121.
  89. Meldrum DR, Moore FA, Moore EE, et al. Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg 1997; 174:667.
  90. Burch JM, Moore EE, Moore FA, Franciose R. The abdominal compartment syndrome. Surg Clin North Am 1996; 76:833.
  91. Mayberry JC, Goldman RK, Mullins RJ, et al. Surveyed opinion of American trauma surgeons on the prevention of the abdominal compartment syndrome. J Trauma 1999; 47:509.
  92. Balogh ZJ, Martin A, van Wessem KP, et al. Mission to eliminate postinjury abdominal compartment syndrome. Arch Surg 2011; 146:938.
  93. De Waele JJ, Kimball E, Malbrain M, et al. Decompressive laparotomy for abdominal compartment syndrome. Br J Surg 2016; 103:709.
  94. An G, West MA. Abdominal compartment syndrome: a concise clinical review. Crit Care Med 2008; 36:1304.
  95. Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg 1984; 199:28.
  96. Cheatham ML, Safcsak K. Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival? Crit Care Med 2010; 38:402.