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International Journal of Surgery Science
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International Journal of Surgery Science
Vol. 5, Issue 1, Part E (2021)

A prospective analysis of intra-abdominal pressures and outcome in patients undergoing emergency laparotomies

Author(s): Dr. M Paul Naveen, Dr. Sangamesh Kamthane and Dr. P Anurag Reddy
Abstract: Background: As many studies have been done upon IAP and its outcome on the patients that Intra-Abdominal Hypertension (IAH) leaves an impact on every organ. In recent times it is strangely under diagnosed. Although IAP is an independent predictor in measuring the morbidity and mortality.
Aim and Objectives: To evaluate changes in various clinical parameters due to increasing Intra-abdominal Pressure and also to evaluate the Morbidity and Mortality in patients who develop abnormal Intra-Abdominal Pressure
Methodology: The present study was a prospective analysis of IAP in patients presenting to surgical emergency of Mahavir Institute of Medical Sciences, Shivareddypet, Vikarabad, Ranga Reddy -Telangana, India.over a period of 1year from December 2019 to December 2020. A total number of 40 patients were assessed with regards to their clinical diagnosis, vital parameters al presentation, IAP and the morbidity and mortality. The SEDREK’S Technique of IAP measurement was used to determine the IAP. In this method, the Foleys catheter is marked as ‘0’, few mm proximal to the Y-junction, which serves as the zero reference point when it is at the level of symphysis pubis.The drainage tubing is marked at an increment of 1 cm on the tape, starting from the mark on the foley’s catheter as ‘0’. Next introduce 50 to 100 ml of sterile saline into the bladder. After reconnecting the Foley’s catheter to the drainage tubing, the zero reference point is kept at the level of pubic symphysis and the drainage tubing is raised vertically.
Result and Conclusion: IAP was found to be a significant predictor of mortality in patients undergoing laparotomy (P<0.001). Elevated IAP was found to affect all the organ systems adversely. The incidence of post-op ACS was 3.05% in the general population and 13.16% in trauma patients. The mortality rate for this subgroup was 100%. Out of a total number of 40 patients 18 patients belonged to this category which is 45%. 5 patients were diagnosed with two day history of intestinal obstruction, 5 patients with two day history of peritonitis, 7 patients with one day history of peritonitis and 1 patients with ruptured liver abscess. The clinical condition of this particular subset of patients was relatively stable when compared to the patients in the other Grades. The average pulse rate was 96/mt, the average systolic blood pressure 98 mmhg and the average respiratory rate 15/mt. Post operative recovery was uneventful without any complication in 14 cases, 4 patients had wound gaping which could be due to other factors.
Hence this study demonstrates that increase in Intra-Abdominal Pressure causes a change in different clinical Parameters. Grade 4 Intr-Abdominal Pressure is associated with Abdominal compartment syndrome and hence with very high mortality. Measurement of Intra-Abdominal Pressure by the Sedrek’s technique is easy, reliable and can underlying physiological status. Intra-Abdominal Pressure measurement can be used as an independent clinical parameter to assess the patients current clinical condition.
Pages: 281-287  |  281 Views  108 Downloads
How to cite this article:
Dr. M Paul Naveen, Dr. Sangamesh Kamthane, Dr. P Anurag Reddy. A prospective analysis of intra-abdominal pressures and outcome in patients undergoing emergency laparotomies. Int J Surg Sci 2021;5(1):281-287. DOI: https://doi.org/10.33545/surgery.2021.v5.i1e.624
International Journal of Surgery Science