Investigating Trans-Vesical and Trans-Gastric intra-abdominal pressures for correlation with intra abdominal damages.

Abstract

Purpose. Increasing intra abdominal pressure is a warning sign interpreted as an unusual intra peritoneal occurrence. Successive measurement of abdominal pressure during management of abdominal damages may help the surgeon better for prompt judgment. Method. A Prospective trial was performed on 50 cases of referral acute abdomens during one year. Intra abdominal Pressure was measured by trans vesical and simultaneously trans gastric methods on admission, pre and post operative for 6,12, 24, 48 hours respectively. The aim of the study was to evaluate the correlation of intra abdominal pressures with intra peritoneal damages or post operative complications during management. Results. 40 males (80%) and 10 females (20%), 14-85 years old (mean40.921.8) were recruited. Overall, 46(92%) cases were discharged in whom 39(78%) were uneventful (33 laparotomies, 6 close observations). 11patients (22%) had complications. There was significant difference between pre and postoperative intra-abdominal pressures in two TV, TG methods respectively (P=0.008 and P=0.02) and between males and females in trans vesical method (P=0.009). Liver packing and evisceration were shown significant range of intra abdominal hypertension amongst the causes. Recorded pressure values between the two methods were similar. Conclusion. Successive intra abdominal pressure measurements were shown to be effective and were according to pre and postoperative intra abdominal damages, more predictive in females by trans vesical method at the time of admission. We conclude that periodic trans vesical measurement for equivocal abdomens, close abdominal observations and post-operative handling of traumatic and pathologic abdomens is mandatory.