INTRA-ABDOMINAL PRESSURE AS ONE OF THE CRITERIA FOR CHOOSING SURGICAL TACTICS IN ACUTE SMALL INTESTINE OBSTRUCTION
DOI:
https://doi.org/10.32689/2663-0672-2025-2-2Keywords:
acute intestinal obstruction, intra-abdominal pressure, intra-abdominal hypertension, surgical tactics, surgical interventionAbstract
Intra-abdominal hypertension is a common complication in acute small bowel obstruction, complicating the course of the disease and increasing the risk of multiple organ failure. Timely measurement of intra-abdominal pressure allows for an objective assessment of the severity of the patient's condition and justifies the choice of surgical treatment tactics. The prognostic significance of intra-abdominal pressure in patients with acute small bowel obstruction makes it an important criterion in determining the urgency and extent of surgical intervention.Methods. The study included 52 patients with verified acute small bowel obstruction who were treated in the surgical departments of the Ternopil Regional Clinical Hospital and Ternopil City Hospital No. 2. All patients underwent intra-abdominal pressure measurement using a transurethral technique via a Foley catheter. Depending on the level of intra-abdominal pressure, patients were divided into three groups according to the degree of intra-abdominal hypertension. Treatment tactics varied from conservative to urgent surgery.Results. The average intra-abdominal pressure in patients with acute small bowel obstruction was 17.61 ± 1.8 mmHg. In group 1 (n = 14), the indicator was 12.8 ± 1.5 mmHg, in the second group (n=17) it was 19.3 ± 2.1 mmHg, and in the third group (n=21) it was 23.7 ± 1.8 mmHg. Patients with grade 1 intra-abdominal hypertension received conservative therapy, patients with grade 2 intra-abdominal hypertension underwent nasogastric or intestinal intubation followed by surgery, and in cases of grade 3 intra- abdominal hypertension, emergency surgery was performed.Conclusions. Monitoring intra-abdominal pressure in patients with acute small bowel obstruction is an important criterion for risk stratification and the choice of surgical tactics. High intra-abdominal pressure correlates with the need for emergency intervention and is a prognostic marker of severity.
References
Dukkipati S. S., Puranik A. K., Meena S. P., Badkur M., Lodha M., Kompally P. V., Chaudhary R., Rodha M. S., Sharma N. An Analysis of the Impact of Intra-abdominal Pressure on Surgical Outcomes in Cases of Intestinal Obstruction: A Prospective Observational Study. Cureus. 2024. 16(5), e59736. doi: 10.7759/cureus.59736.
Hatipoglu S., Akbulut S., Hatipoglu F., Abdullayev R. Effect of laparoscopic abdominal surgery on splanchnic circulation: historical developments. World J Gastroenterol. 2014. 20(48), 18165–76. doi: 10.3748/wjg.v20.i48.18165.
Krycky I. O., Hoshchynskyi P. V., Shulhai O. M., Dzhyvak V. G., Protsailo M. D. Improving an integrated approach to the treatment of functional constipation in children. Paediatric Surgery. Ukraine. 2023. (4(81)), 87–91. doi:10.15574/ps.2023.81.87
Łagosz P., Sokolski M., Biegus J., Tycinska A., Zymlinski R.. Elevated intra-abdominal pressure: A review of current knowledge. World J Clin Cases. 2022. 10(10), 3005–3013. doi: 10.12998/wjcc.v10.i10.3005.
Leon M., Chavez L., Surani S. Abdominal compartment syndrome among surgical patients. World J Gastrointest Surg. 2021. 13(4), 330–339. doi: 10.4240/wjgs.v13.i4.330.
Li R. T., Zhao Y., Zou X. J., Shu H. Q., Zhou T., Pan S. W., Gao X. H., Huang H. Y., Liu H., Shang Y. Overview of point- of-care ultrasound in diagnosing intestinal obstruction. World J Emerg Med. 2022. 13(2), 135–140. doi: 10.5847/wjem.j.1920-8642.2022.048.
Li Z., Lu F., Wu J., Dai Y., Wang Y., Zheng L., Wang H. Awareness, knowledge and practices related to intra-abdominal hypertension and abdominal compartment syndrome among intensive care providers: a systematic scoping review. Ann Intensive Care. 2025. 15(1), 106. doi: 10.1186/s13613-025-01521-4.
Liao C. H., Cheng C. T., Chen C. C., Wang Y. H., Chiu H. T., Peng C. C., Jow U. M., Lai Y. L., Chen Y. C., Ho D. R. Systematic Review of Diagnostic Sensors for Intra-Abdominal Pressure Monitoring. Sensors (Basel). 2021. 21(14), 4824. doi: 10.3390/s21144824.
Lin Y. M., Fu Y., Winston J., Radhakrishnan R., Sarna S. K., Huang L. M., Shi X. Z. Pathogenesis of abdominal pain in bowel obstruction: role of mechanical stress-induced upregulation of nerve growth factor in gut smooth muscle cells. Pain. 2017. 158(4), 583–592. doi: 10.1097/j.pain.0000000000000797.
Marjanovic V. G., Budic I. Z., Zecevic M. D., Stevic M. M., Simic D. M. Intra-abdominal hypertension/abdominal compartment syndrome of pediatric patients in critical care settings. Open Med (Wars). 2025. 20(1), 2025–1244. doi: 10.1515/med-2025-1244.
Nelms D. W., Kann B. R. Imaging Modalities for Evaluation of Intestinal Obstruction. Clin Colon Rectal Surg. 2021. 34(4), 205–218. doi: 10.1055/s-0041-1729737.
Papavramidis T. S., Marinis A. D., Pliakos I., Kesisoglou I., Papavramidou N. Abdominal compartment syndrome – Intra- abdominal hypertension: Defining, diagnosing, and managing. J Emerg Trauma Shock. 2011. 4(2), 279–291. doi: 10.4103/0974- 2700.82224.
Tang H., Liu D., Guo Y., Zhang H., Li Y., Peng X., Wang Y., Jiang D., Zhang L., Wang Z.. A New Device for Measuring Abdominal Wall Tension and Its Value in Screening Abdominal Infection. Med Devices (Auckl). 2021. 14, 119–131. doi: 10.2147/ MDER.S291407.
Zarnescu N. O., Dumitrascu I., Zarnescu E. C., Costea R. Abdominal Compartment Syndrome in Acute Pancreatitis: A Narrative Review. Diagnostics (Basel). 2022. 13(1), 1. doi: 10.3390/diagnostics13010001.
