Secondary abdominal compartment syndrome in postoperative period in patients with tumors of sellar region

The abdominal compartment syndrome (ACS) can lead to multiple organ dysfunction syndrome (MODS), sepsis and death. In neurosurgical patients ACS used to be interesting for specialists only in respect of its impact on ICP. However injury of diencephalic structures of the brain can theoretically cause ACS. The goal of the study is to assess the efficacy of conservative therapy and epidural anesthesia for ACS treatment in postoperative period in patients with tumors of the sellar region. 41 patients were enrolled in the study. The epidural anesthesia at T8-T9 level by bupivacaine was applied for three days in the case of ACS development and ineffective conservative therapy. Intra-abdominal hypertension (IAH) developed in 28 cases, ACS - in 9. IAN usually revealed itself on the second day after surgery, ACS - on the 3rd-6th day. Gastrointestinal tract paralysis developed earlier than IAH and continued longer than IAH. Conservative therapy was effective only in every third patient with ACS. Epidural anesthesia was used in 4 cases and appeared effective in all of them. All patients with ACS not provided by epidural anesthesia died. We conclude that conservative therapy is effective in IAH, but not in ACS cases. Epidural anesthesia is an effective method to treat ACS and should be used in all patients with ACS without sepsis.