SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 2 | 23 The WSACS1 recommend non-invasive measures first in the management of ACS in AP. This includes decreasing intra-luminal content (by nasogastric decompression, colonic lavage, prokinetic use), percutaneous drainage of intra- abdominal collections, improving abdominal wall compliance (via neuromuscular blockade, sedation, analgesia), and optimising fluid administration and organ support. This, with the important caveat, that patients that have overt ACS with haemodynamic compromise or collapse be taken for immediate decompressive laparotomy. It has been shown in multiple studies 2, 3, 5, 7 that delay to surgical decompression in such patients increases mortality. Mentula et al 7 described an overall hospital mortality for patients with pancreatitis and ACS of 46%, but a mortality rate of only 18% when decompressive laparotomy was performed within the first 4 days of disease onset. In that particular study, time to surgical decompression was a statistically significant risk factor for a fatal outcome. In addition, as many as half of patients initial treated conservatively with percutaneous drainage eventually required surgical decompression 4 . Abdominal decompression can result in substantial morbidity related to an “open abdomen” including bowel fistulas and giant ventral hernia 7 . WSACS1 recommends negative pressure wound therapy for an open abdomen and to attempt fascial closure during index hospital stay, however sheath and skin closure is not always possible post decompressive laparostomy and non-closure should not be considered a treatment failure 3 . Conclusion Abdominal compartment syndrome is an under-recognised and under-treated complication of acute severe pancreatitis, and usually occurs early in the disease course. Early detection with early decompression can alter disease outcome and improve mortality in patients with AP. References 1. Kirkpatrick AW, Roberts DJ, De Weale J, Jaeschke R, Mal- brain MLNG, De Keulenaer B, et al. Intra-abdominal hyper- tension and the abdominal compartment syndrome: updated consensus definitions and clinical practise guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med. 2013; 39: 1190-1206. 2. De Waele JJ. Management of Abdominal Compartment Syn- drome in Acute Pancreatitis. Panc. 2015; 29. 3. Siebert M, Le Fouler A, Sitbon N, Cohen J, Abba J, Poupar- din E. Management of abdominal compartment syndrome in acute pancreatitis. Journal of Visceral Surgery. 2021; 01: 1138-1147. 4. Van Brunschot S, Schut AJ, Bouwense SA, Besselink MG, Bakker OJ, van Goor H et al. Abdominal Compartment Syn- drome in Acute Pancreatitis. Pancreas. 2014; 43: 665-674. 5. Jaipuria J, Bhandari V, Chawla AS, Singh M. World J Gastro- intest Pathophysio. 2016; 7(1): 186-198. 6. Lee AHH, Lee W, Anderson D. Severe pancreatitis compli- cated by abdominal compartment syndrome managed by decompressive laparotomy: a case report. BMC Surgery. 2019; 19: 113-119. 7. Mentula P, Hienonen P, Kemppainen E, Puolakkainen P, Lep- paniemi A. Surgical Decompression for Abdominal Compart- ment Syndrome in Severe Acute Pancreatitis. Arch Surg; 145 (8): 764-769. CASE REPORT CASE REPORT thrombophilia w s considere etiology for the portal vein an Ca-125 level was ultimately co in view of the chronic underlyi Figure 1: Sagittal view of the l Colour Flow Doppler demonst vascular channels in the area remnant. Figure 2: CT abdomen images demonstrating the venous clu of the portal vein (cavernous t