Abdominal compartment syndrome in dogs: how to measure it

Question

30 kg crossbreed with traumatic haemoabdomen, treated with large fluid volumes, transfusion and an abdominal counter-pressure bandage. At 10 hours the abdomen is very tense, urine output has fallen below 0.5 mL/kg/h and the respiratory rate has increased.

You suspect abdominal compartment syndrome. How do you best confirm it?

chevron_right Show answer and explanation

A. With an abdominal radiograph to see the amount of fluid

Radiographs show loss of detail but do not measure pressure. The amount of fluid does not correlate well with the effect on organs.

B. By measuring intravesical pressure through a urinary catheter connected to a manometer or transducer

Correct. Bladder pressure, with a small volume of saline instilled and zero at the pubic symphysis, reflects intra-abdominal pressure. High and rising values with organ dysfunction confirm the syndrome and require decompression (removing the bandage, drainage or, if insufficient, laparotomy).

C. By measuring central venous pressure, which will be low

Intra-abdominal hypertension tends to falsely raise central venous pressure as pressure is transmitted to the thorax, so it cannot confirm it and may confuse volume assessment.

D. With FAST, looking for more positive windows than on admission

FAST shows whether there is more fluid but does not measure pressure or its consequences. An abdomen with little fluid may have high pressure due to bowel oedema or an overly tight bandage.

lightbulb Key takeaway

Think of intra-abdominal hypertension in patients with haemoabdomen, counter-pressure bandages, massive fluid therapy, pancreatitis or after laparotomy. Oliguria, hypotension and respiratory difficulty with a tense abdomen are the warning signs. Measure intravesical pressure serially.

You suspect abdominal compartment syndrome. How do you best confirm it?

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