Das abdominelle Compartmentsyndrom - ein in der Gastroenterologie weitgehend unbekanntes Krankheitsbild

Zusammenfassung

Ein anhaltend erhöhter intraabdomineller Druck kann das kardiovaskuläre System, die Atmung und Nierenfunktion stören und letztendlich zum Multiorganversagen führen. Dieses Problem wird vor allem auf chirurgischen Intensivstationen angetroffen und tritt bei Operationen an Dünn- und Dickdarm, bei abdominellen Gefäßeingriffen und im Gefolge von Bauchtraumen gehäuft auf. Ein Expertengremium hat die Erhöhung des intraabdominellen Drucks auf Werte > 20 mmHg in Verbindung mit einer neu aufgetretenen Organdysfunktion als „abdominelles Compartmentsyndrom” definiert. Diese Krankheitsentität ist in der Gastroenterologie wenig bekannt, obwohl sie als Komplikation einer endoskopischen Perforation mit Ausbildung eines Spannungspneumoperitoneums auftreten kann. Mit der Verbreitung laparoskopischer Prozeduren erscheint es angebracht, auf die Bedeutung des Druckmonitorings zur Vermeidung dieser potenziell letalen Komplikation zu verweisen.

Abstract

A sustained increase in intra-abdominal pressure may derange cardiovascular haemodynamics, respiratory and renal functions and finally lead to multi-organ failure. It is primarily seen in surgical intensive care units and is most frequently associated with small and large bowel surgery, vascular surgery, and abdominal trauma. An expert panel has defined elevated intra-abdominal pressure > 20 mmHg in conjunction with newly occurring organ dysfunction as “abdominal compartment syndrome” (ACS). This entity is not well recognised in gastroenterology, although ACS may occur as a complication of endoscopic perforation resulting in tension pneumoperitoneum. With the propagation of laparoscopic procedures it may be appropriate to emphasise the importance of intra-abdominal pressure monitoring in order to avoid this potentially lethal complication.

Schlüsselwörter

Kolonoskopie - Perforation - Spannungspneumoperitoneum - abdominelles Compartmentsyndrom

Key words

colonoscopy - perforation - tension pneumoperitoneum - abdominal compartment syndrome

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