Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are complex diseases that are common among patients who are critically ill or injured. If either you or someone you love has been diagnosed with either IAH or ACS, this is no doubt a very stressful time for you and your family. You likely have many questions. We encourage you to speak with your physicians and nurses regarding your current illness as they are best equipped to answer questions related to your specific situation. We hope that the following will help to augment the information you receive from your healthcare providers.
Most patients with IAH and/or ACS will be cared for in an intensive care unit (ICU) where doctors and nurses constantly watch ("monitor") for signs of illness and treat ("resuscitate") patients to keep their heart, lungs, kidneys, liver, and intestines functioning as normally as possible. Many patients will require a breathing machine ("mechanical ventilator") to help them breath and receive enough oxygen. They will receive medications for pain and to keep them calm. They will also receive medications such as antibiotics and blood pressure medications to help them heal.
Frequently Asked Questions
What is intra-abdominal pressure (IAP)?IAP is the pressure within the abdomen. This pressure is normally very low, but can be increased during illness and injury due to swelling or internal bleeding. IAP may be measured in a variety of ways, but is most commonly measured using the catheter that is already present in the patient's bladder to collect urine. As a result, IAP is commonly referred to as the "bladder pressure".
What is Intra-Abdominal Hypertension (IAH)?IAH is an increase in the normal pressure within the abdomen that can cause a patient's heart, lungs, kidneys, liver, and intestines to become sick and not function properly.
What is Abdominal Compartment Syndrome (ACS)ACS is a severe increase in the pressure within the abdomen ("intra-abdominal pressure" or IAP) such that a patient's internal organs begin to fail and malfunction. This is a medical emergency. Untreated, ACS has a high mortality rate. There are a number of different methods that your doctors may use to treat the ACS. These may include giving medications to sedate or temporarily paralyze you or your loved one, placing tubes through the nose and into the stomach to remove fluid and air, placing tubes into the abdomen to remove fluid or blood, or opening the abdomen to release the increased pressure.
What is an "open abdomen"?An operation where your doctor makes a large incision (cut) in your abdomen (belly) and leaves this incision open to relieve the high pressure that is preventing your organs from working properly. You will need another operation (or sometimes many) to close this incision when you are no longer sick. While your abdomen is "open" in the hospital, you will have a special covering to protect your organs. This operation is also known as "abdominal decompression".
Why is an open abdomen necessary?Organ failure, such as your heart, lungs or kidneys not working properly, is the most common cause of death in the intensive care unit (ICU). Your doctors and nurses will do everything possible to prevent your organs from failing. If all other therapies fail, however, opening your abdomen may be the only way to save your life.
How can I tell whether my abdomen is "open" or "closed"?To close an open abdomen, your surgeon will sew both the skin AND muscles of your abdominal wall back together. Your abdomen is considered "closed" when BOTH layers of the abdomen have been repaired. You may, however, be too sick to close both layers at the same time. If this is so, your surgeon may sew only your skin together (called a "skin-only" closure) leaving your muscles apart to keep the pressure in your abdomen low. If this is not possible, your surgeon will take a piece of your skin (usually from the thigh) and place this over your organs (called a "skin graft" closure). In either case, you will have a hernia (a large bulge in your belly) until your surgeon feels you are ready to have another operation to close the muscle layer as well. While you have a hernia, you will need to follow the activity restrictions given to you by your surgeon. You may also need to wear an abdominal "binder" or "belt" to support your abdominal wall. Until both the skin and muscles of your abdominal wall have been sewn together, your doctors will consider your abdomen as being "open".
Why do I have an open abdomen?Because you are/were so sick, your doctor had to open your abdomen to save your life and prevent organ failure. In most patients, an open abdomen is temporary and your abdomen should be able to be closed in the near future.
"When will my abdomen be closed?"Your abdomen will be closed as soon as you have recovered from your injury or illness. In most patients, this will be within a week or two. You may need several operations to close your abdomen depending upon how sick you are. If you are seriously ill orinjured, you may not be able to have your abdomen closed right away and may need an operation to temporarily cover the abdomen with skin (either a "skin graft" or "skin-only" closure). You will then need to go home and recover for 3 to 12 months before you can have another operation to close your abdomen permanently.
Can I work or go to school with my abdomen open?Depending on what type of work you normally do, you may be able to work while your abdomen is open. You will not be able to lift heavy objects until your abdomen is closed. Your doctor will talk with you about your work and school restrictions. Once your abdomen is closed, you should be able to resume your usual activities.
Is it normal for my abdomen to hurt when I move?Occasional crampy pain is common in the months following surgery. This will resolve over time. If the pain worsens, or you begin having nausea, vomiting, or fever, you should notify your doctor immediately.
Will my abdomen always look like this?In most patients, an open abdomen is temporary. Once you have recovered from your initial injury or illness, your surgeon will begin plans to close your abdomen.
Important Issues If You Have An Open Abdomen
You should always follow the instructions and advice of your surgeon and other physicians. The following recommendations apply to most patients with an open abdomen.
- You should exercise everyday. Walking is best.
- Do not lift weights or perform strenuous exercise without checking with your doctor first.
- Eat a balanced, healthy diet and avoid excessive weight gain. If you gain too much weight, you may not be able to have your abdomen closed. Regular exercise and a low-fat diet are the best way to avoid gaining too much weight.
- Don't be surprised if you get tired easily. Your body is healing and needs lots of rest. It may take up to a year to regain your normal strength.
- Be sure to follow-up regularly with your surgeon and follow his or her instructions.
- Follow all of the instructions provided by your physician or nurse.
The World Society of the Abdominal Compartment Syndrome (WSACS) was founded in 2004 to promote research, foster education, and improve the survival of patients with intra-abdominal hypertension (IAH) and/or abdominal compartment syndrome (ACS). The WSACS is a non-profit organization whose educational efforts are dependent upon philantrophic educational grants from our industry partners as well as donations from patients, families, and others. The WSACS greatly appreciates the generous financial assistance of its partners without whose help the mission of the WSACS could not occur.
If you or your family has been impacted by IAH/ACS and would like to partner with the WSACS to improve the diagnosis and management of IAH/ACS, please contact the WSACS Executive Committee. All donations to the WSACS are tax-deductible to the full extent allowable by law. Complete documentation of your donation to the WSACS will be provided for such purposes. Donations may also be made in the name of a family member or that of physicians and nurses whom you would like to see recognized for their dedication to patient care.
Please contact the WSACS Executive Committee for further information regarding philanthropic donations to the Society.