A prospective evaluation of CT features predictive of intra-abdominal hypertension and abdominal compartment syndrome in critically ill surgical patients

• Published in: Clinical radiology 2007-07, Vol.62 (7), p.676-682
• Main Authors: Al-Bahrani, A.Z, Abid, G.H, Sahgal, E, O'Shea, S, Lee, S, Ammori, B.J
• Format: Article
• Language: English
• Subjects: Abdomen; Acute Disease; Adult; Aged; Biological and medical sciences; Compartment Syndromes - diagnostic imaging; Compartment Syndromes - etiology; Compartment Syndromes - physiopathology; Critical Illness; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Length of Stay; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Pancreatitis, Chronic - diagnostic imaging; Pancreatitis, Chronic - etiology; Pancreatitis, Chronic - physiopathology; Pressure; Prospective Studies; Radiography, Abdominal - methods; Radiology; Sensitivity and Specificity; Sepsis - physiopathology; Sepsis - radiotherapy; Tomography, X-Ray Computed - standards
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2006.11.006

Aim The aim of this study was to validate the computed tomography (CT) features of intra-abdominal hypertension (IAH) by relating them to the clinical measurement of intra-abdominal pressure (IAP) in critically ill surgical patients. Materials and methods The intra-vesical pressure was measured to reflect IAP in 24 critically ill patients. CT examinations obtained within 24 h of IAP measurement were reviewed and scored independently by two consultant radiologists. Each CT examination was scored for the seven proposed features of IAH. Images obtained during the presence of IAH were compared with those obtained in the absence of IAH. Results Forty-eight abdominal CT examinations were evaluated, of which 18 (38%) were obtained in the presence of IAH, whereas eight (17%) were obtained in the presence of abdominal compartment syndrome (ACS). At CT, the round belly sign (RBS) and bowel wall thickening with enhancement (BWTE) were significantly more frequently detected during the presence of IAH than when the IAP was less than 12 mmHg (78 versus 20% of examinations, p < 0.001 and 39 versus 3% of examinations, p = 0.003, respectively), but only BWTE was significantly associated with the presence of ACS (40 versus 11% of examinations, p = 0.047). Conclusion The presence of RBS and BWTE on CT images of critically ill surgical patients should alert clinicians to the possibility of presence of IAH and ACS, and prompt measurement of the IAP and consideration of suitable interventions.