Comprehensive assessment of the relationship between indicators of systemic intoxication and intra-abdominal pressure at the patients operated for peritonitis
Authors: Perekhodov S. N. , Popov Y. P. , Evdokimov V. V. , Popov P. A. , Dubovitsky K. I. 
Published: July 2023

According to the latest statistical data, 22% of patients with emergency abdominal surgical pathology are admitted to medical institutions with signs of peritonitis. Despite modern methods of treatment and diagnosis, the mortality rate for this pathology remains at the same level and is approximately 18–29%, and in advanced forms can reach 75–90%. Recent studies show that in an unfavorable outcome of this pathological process, a leading role is given to a progressive increase in intraabdominal pressure (IAP). The relationship between the degree of endogenous intoxication and IAP values makes it possible to quickly assess the severity of the patient’s condition and the state of central hemodynamics without additional laboratory and instrumental studies. The aim of the study was to evaluate the indicators of systemic endogenous intoxication and intraabdominal pressure and their relationship in patients with peritonitis in the pre- and postoperative period. Material and methods. This work is based on a retrospective analysis of 74 patients operated on at the clinical bases of the Department of Hospital Surgery of the Moscow State Medical University named after A.I. Evdokimov for peritonitis from January to October 2022. The main causes of acute peritonitis were perforated ulcer of the stomach or duodenum, acute intestinal obstruction, thrombosis of mesenteric vessels, acute pancreonecrosis, complicated colon cancer. The average age of patients was 49 ± 2.5 years (34-75 years), 47 women, 27 men. The severity of peritonitis was assessed based on the degree of endotoxemia according to clinical and laboratory data. To monitor intra-abdominal hypertension, IAP was measured. IAP measurement was performed on the operating table before surgery and in the early postoperative period. At the same time, compartment syndrome of the first degree was found in 51 (68%) patients, the second degree in 14 (19%) patients, and the third-fourth degree in 9 (13%) patients. For a comprehensive assessment of the patient’s condition and the eﬀectiveness of the measures taken, the central hemodynamics was assessed and its relationship with the indicators of intra-abdominal pressure was evaluated. Comparative analysis of central hemodynamics manometry showed that with an increase in compartment syndrome, there is a clear decrease in the performance of cardiac activity indicators, requiring urgent correction. The relationship between indicators of intra-abdominal pressure and the duration of preoperative preparation was also evaluated. Conclusions. The relationship between the degree of endogenous intoxication and the degree of intra-abdominal pressure has been proven. With an increase in IAP values, the values of endogenous intoxication increase, which subsequently leads to the development of multiple organ failure. Even with the first degree of endogenous intoxication, a decrease in myocardial contractile ability is noted, which leads to the development of cardiovascular failure depending on the severity of the pathological process. The diagnosis of increased IAP syndrome has great practical value for detecting pathology and timely comprehensive treatment in the pre- and postoperative period.