AIM: To study the effect of combined indwelling catheter, hemofiltration, respiration support and traditional Chinese medicine (e.g. Dahuang) in treating abdominal compartment syndrome of fulminant acute pancreatitis.

METHODS: Patients with fulminant acute pancreatitis were divided randomly into 2 groups of combined indwelling catheter celiac drainage and intra-abdominal pressure monitoring and routine conservative measures group (group 1) and control group (group 2). Routine non-operative conservative treatments including hemofiltration, respiration support, gastrointestinal TCM ablution were also applied in control group patients. Effectiveness of the two groups was observed, and APACHE II scores were applied for analysis.

RESULTS: On the second and fifth days after treatment, APACHE II scores of group 1 and 2 patients were significantly different. Comparison of effectiveness (abdominalgia and burbulence relief time, hospitalization time) between groups 1 and 2 showed significant difference, as well as incidence rates of cysts formation. Mortality rates of groups 1 and 2 were 10.0% and 20.7%, respectively. For patients in group 1, celiac drainage quantity and intra-abdominal pressure, and hospitalization time were positively correlated (r = 0.552, 0.748, 0.923, P < 0.01) with APACHE II scores.

CONCLUSION: Combined indwelling catheter celiac drainage and intra-abdominal pressure monitoring, short veno-venous hemofiltration (SVVH), gastrointestinal TCM ablution, respiration support have preventive and treatment effects on abdominal compartment syndrome of fulminant acute pancreatitis.

There are certain guidelines for treatment of severe acute pancreatitis (SAP). However, about 11% of SAP patients suffer from the complication of abdominal compartment syndrome (ACS), and about 25% of SAP patients are fulminant acute pancreatitis (FAP). Incidence rate of ACS is higher in FAP, and its mortality rate is as high as 60%. Up till now, there have been no standard treatments for ACS[1,2]. In the present study, we used combination of celiac indwelling catheter drainage and intra-abdominal pressure monitoring, several short veno-venous hemofiltration (SVVH), respiration support and gastrointestinal TCM ablution for treatment and predicting patient’s conditions of ACS in FAP. Through comparison with the control group, we demonstrate that the combined therapy is effective for treatment of ACS.

FAP is characterized by rapid deterioration of patient’s conditions. Multi-organ (specially pancreas and gastrointestinal tract) dysfunction appeared in early stage.

ACS in FAP is divided into four grades according to IAP: first grade is 10-14 cm H₂O, second grade is 15-24 cm H₂O, third grade is 25-35 cm H₂O, and fourth grade is > 35 cm H₂O. In group 1 of our experiment, celiac intra-abdominal pressure of 45 cases was 29.29 ± 5.53 cm H₂O, diagnosed as ACS clinically[4-6]. Currently, ACS is detected mainly by bladder manometry method, which is an indirect method. However, there are certain influencing factors. Therefore we used indwelling catheter celiac laying canal to directly detect intra-abdominal pressure, and performed canal drainage. It could prevent celiac dropsy ACS, avoid disturbance of celiac function when operating, and the effect of anesthesia on laparotomy and celiac operation, and consequently prevent ACS[7-12]. In our study, the combined approach of indwelling catheter drainage, SVVH and gastrointestinal TCM ablution, respiration support and use of other drugs was employed to treat ACS in FAP. We found that drain quantity was positively correlated with intra-abdominal pressure (r = 0.55), and intra-abdominal pressure was correlated with hospitalization time and APACHE II cumulative scorings (r = 0.75, 0.92). In comparison of effectiveness, that of the group 1 was significantly better than that of group 2 regarding abdominalgia disappearing time, burbulence relief time, and hospitalization time (P = 0.000); mortality rates were 10% and 20.7% in group 1 and 2, respectively; incidence rates of cysts between the two groups were significantly different (P = 0.001). The reasons for the better effect of group 1 might be that: (1) indwelling catheter drainage eliminated ACS caused by celiac dropsy; (2) hemofiltration or drainage improved paralysis of gastrointestinal tract caused by a variety of inflammatory cytokines, inflammation mediators, all kinds of enzymes and necrosis materials (including large, moderate and small molecular weight materials). As a consequence, damage of tissues and organs in dropsy (mesentery, epiploon, gastrointestinal and parietal peritoneal membrane) type of ACS was greatly reduced; (3) It was eliminated that the celiac disturbance and the effect on systemic multi-organs (especially gastrointestinal tract) caused by laparoscopic operation or laparotomy and anesthesia; (4) TCM, eg. Dahuang could effectively reduce intestinal tract endotoxin and bacterial shift, alleviate intestinal mucosal membrane damage, and facilitate gastrointestinal movement and emptying[9,13-16]. As far as we know, such study has not been reported.

In summary, combined indwelling catheter celiac drainage, intra-abdominal pressure monitoring, multi-SVVH, gastrointestinal TCM ablution, respiration support and use of drugs can prevent and treat ACS in FAP effectively. However, the problem of slow speed of indwelling catheter celiac drainage has still to be resolved[13].