Avoidance of abdominal compartment syndrome in damage-control laparotomy after trauma.

Abstract

THE MODERN era of damage-control laparotomy began with the seminal report of Stone et al¹ from the Grady Memorial Hospital, Atlanta, Ga, in 1982. Compared with a historical control survival of 1 (7%) of 14 patients, 11 (65%) of 17 patients sustaining predominantly penetrating wounds survived after abdominal packing. During the next 5 years, the practice of damage-control laparotomy became widely accepted as the standard of care in the management of trauma manifesting the "bloody vicious cycle" of hypothermia, acidosis, and coagulopathy. With widespread application and intense study, previously unrecognized complications began to emerge. Recently, abdominal compartment syndrome (ACS), defined as end-organ dysfunction secondary to intra-abdominal hypertension, has been emphasized. Although the adverse effects of elevated intra-abdominal pressure have been recognized for more than a century, it is only in the 1990s that ACS has been rediscovered and more comprehensively characterized. Despite this concentrated investigation, several important questions remain.