A Prospective Study to Measure Intra-Abdominal Pressure Following Emergency Exploratory Laparotomy And To Correlate It With Measurable Post-Operative Outcomes

Abstract

Background: Several studies have documented the detrimental effects of Intra Abdominal Hypertension (IAH) and Abdominal Compartment Syndrome (ACS), however it remains largely under diagnosed. ACS is the end sequela of raised intra-abdominal pressure (IAP), defined as a sustained IAP >20 mmHg with or without an abdominal perfusion pressure <60 mmHg and associated with new organ dysfunction. Objectives: In this study my aim is to measure the intra abdominal pressures of patients following emergency exploratory laparotomy and to identify the presence of ACS and to see if there is any correlation between IAP measurements and major post operative outcomes. Methodology: 55 patients undergoing Emergency Exploratory Laparotomy.in the Department of General Surgery in Government Medical College, Kozhikode were studied. IAP was monitored at 0hrs, 6hrs, 12hrs, 24hrs, 48hrs and 72hrs post operatively and patient was monitored for development of complications and ACS. IAP was measured indirectly by measuring urinary bladder pressure using foleys catheter. Results: IAH was found to be a significant predictor for development of post operative cardiac, renal and respiratory complications. No significant association was found between IAP and occurrence of burst abdomen or wound related complications. Out of 55 patients studied 14 patients (25.5%) developed ACS. Conclusion: IAP is a significant predictor of mortality in patients undergoing emergency laparotomy. IAH has detrimental effects on various organ systems. A more frequent monitoring with prompt decompression may be helpful in decreasing the mortality rate.