Jiten Jaipuria1, Vimal Bhandari1, Avneet Singh Chawla1, Mohit Singh1. 1. Jiten Jaipuria, Vimal Bhandari, Avneet Singh Chawla, Mohit Singh, Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India.
Abstract
AIM: To systematically review evidence on pathophysiology of intra-abdominal pressure (IAP) in acute pancreatitis (AP) with its clinical correlates. METHODS: Systematic review of available evidence in English literature with relevant medical subject heading terms on PubMed, Medline and Scopus with further search from open access sources on internet as suggested by articles retrieved. RESULTS: Intra-abdominal hypertension (IAH) is increasingly gaining recognition as a point of specific intervention with potential to alter disease outcome and improve mortality in AP. IAH can be expected in at least 17% of patients presenting with diagnosis of AP to a typical tertiary care hospital (prevalence increasing to 50% in those with severe disease). Abdominal compartment syndrome can be expected in at least 15% patients with severe disease. Recent guidelines on management of AP do not acknowledge utility of surveillance for IAP other than those by Japanese Society of Hepato-Biliary-Pancreatic Surgery. We further outline pathophysiologic mechanisms of IAH; understanding of which advances our knowledge and helps to coherently align common observed variations in management related conundrums (such as fluid therapy, nutrition and antibiotic prophylaxis) with potential to further individualize treatment in AP. CONCLUSION: We suggest that IAP be given its due place in future practice guidelines and that recommendations be formed with help of a broader panel with inclusion of clinicians experienced in management of IAH.
AIM: To systematically review evidence on pathophysiology of intra-abdominal pressure (IAP) in acute pancreatitis (AP) with its clinical correlates. METHODS: Systematic review of available evidence in English literature with relevant medical subject heading terms on PubMed, Medline and Scopus with further search from open access sources on internet as suggested by articles retrieved. RESULTS:Intra-abdominal hypertension (IAH) is increasingly gaining recognition as a point of specific intervention with potential to alter disease outcome and improve mortality in AP. IAH can be expected in at least 17% of patients presenting with diagnosis of AP to a typical tertiary care hospital (prevalence increasing to 50% in those with severe disease). Abdominal compartment syndrome can be expected in at least 15% patients with severe disease. Recent guidelines on management of AP do not acknowledge utility of surveillance for IAP other than those by Japanese Society of Hepato-Biliary-Pancreatic Surgery. We further outline pathophysiologic mechanisms of IAH; understanding of which advances our knowledge and helps to coherently align common observed variations in management related conundrums (such as fluid therapy, nutrition and antibiotic prophylaxis) with potential to further individualize treatment in AP. CONCLUSION: We suggest that IAP be given its due place in future practice guidelines and that recommendations be formed with help of a broader panel with inclusion of clinicians experienced in management of IAH.
Entities:
Keywords:
Abdominal compartment syndrome; Intra-abdominal hypertension; Pancreatitis; Practice guideline
Authors: Ari Leppäniemi; Matti Tolonen; Antonio Tarasconi; Helmut Segovia-Lohse; Emiliano Gamberini; Andrew W Kirkpatrick; Chad G Ball; Neil Parry; Massimo Sartelli; Daan Wolbrink; Harry van Goor; Gianluca Baiocchi; Luca Ansaloni; Walter Biffl; Federico Coccolini; Salomone Di Saverio; Yoram Kluger; Ernest Moore; Fausto Catena Journal: World J Emerg Surg Date: 2019-06-13 Impact factor: 5.469