![]() Compartment syndrome is a surgical emergency characterised by increased pressure within a closed space.Other complications of compartment syndrome include: 6 If prompt intervention is not performed, patients may develop irreversible neurovascular damage of the affected limb. 8Ībdominal compartment syndrome is treated by surgical decompression in the form of a laparotomy. The gold standard for monitoring intra-abdominal pressure is via a transducer connected to a urinary bladder catheter. Typical diagnostic criteria include an intra-abdominal pressure of >20mmHg with evidence of multi-organ failure. Causes include retroperitoneal bleeding, reperfusion injury and bowel obstruction. Abdominal compartment syndrome can lead to multi-organ failure and death. The mechanism is the same the abdominal wall can expand to a certain extent beyond which compliance is not possible. Removal of any circumferential casts or bandagesĬompartment syndrome can also occur in the abdomen, which has a normal pressure of 0-5mmHg.Initial management of compartment syndrome should also include: 8 This should be done within one hour of diagnosis. This involves opening the fascial compartment affected to relieve the pressure within the compartment. Surgical decompression through an emergency fasciotomy is the mainstay of treatment. 8Ī difference between the diastolic blood pressure and the compartment pressure of less than 30 mmHg implies an increased risk of compartment syndrome.Īn absolute intra-compartmental pressure of > 40 mmHg with clinical signs is diagnostic of acute compartment syndrome. This is especially useful in unconscious patients. ![]() While compartment syndrome is diagnosed clinically, intra-compartmental pressure monitoring using a needle connected to a transducer can be performed. ![]() The limb may be tense on palpation and difficult to mobilise.Pain out of proportion to the clinical findings, particularly during passive stretching (passive dorsiflexion).Typical clinical findings associated with compartment syndrome include: 4,7 Whether any analgesia has been given (as this can mask the onset of acute compartment syndrome).The timing of the injury and when the patient is assessed.Other important areas to cover in the history include: Disproportionate pain that increases with timeĪt later stages, patients may also develop: 4.Typical symptoms of compartment syndrome include: orthopaedic repair, post-embolectomy, post-laparotomy) ![]() Risk factors for compartment syndrome include: Anatomy of compartments in the lower limb. This leads to muscle ischaemia and necrosis. This causes the build-up and subsequent extravasation of fluid out of the capillaries which further increases the pressure within a closed myofascial compartment.įurthermore, the distribution of oxygen and nutrients and the removal of carbon dioxide is disrupted. When there is injury, bleeding, swelling or overall disruption to the pressure gradient, the flow is disrupted and affects the capillary perfusion pressure. 1īlood flows from a high-pressure arterial system to a low-pressure venous system and a homeostatic pressure gradient is maintained. The normal pressure within the limbs is between 12-18mmHg. Each compartment is covered by a tough membrane called fascia which is resistant to expansion and stretching. Within each compartment, there are muscles, blood vessels and nerves. The limbs are divided into various compartments. You might also be interested in our surgical flashcard collection which contains over 500 flashcards that cover key surgical topics.
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