From the Guidelines
Abdominal wall blanching is primarily caused by intra-abdominal hypertension (IAH), which leads to decreased perfusion to the abdominal wall 1.
Key Factors Contributing to IAH
- Increased intra-abdominal contents: such as acute pancreatitis, hemoperitoneum, or intra-peritoneal fluid collections 1
- Diminished abdominal wall compliance: due to conditions like abdominal surgery, major trauma, or major burns 1
- Visceral swelling: or intra-peritoneal leakage 1
Clinical Implications
The presence of abdominal wall blanching may indicate visceral ischemia and should not be ignored 1.
Management
Addressing the underlying cause of IAH is crucial, and may involve measures to reduce intra-abdominal pressure, such as nasogastric decompression or paracentesis 1. In severe cases, surgical intervention may be necessary to relieve pressure and restore perfusion to the abdominal wall 1.
From the Research
Causes of Abdominal Wall Blanching
The exact cause of abdominal wall blanching is not directly mentioned in the provided studies. However, the studies discuss the effects of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) on abdominal wall compliance and perfusion:
- Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) can lead to decreased perfusion of abdominal viscera and possible difficulties with ventilation and maintenance of cardiac output 2.
- Improvement of abdominal wall compliance is one of the therapeutic goals in the nonoperative management of IAH/ACS 3, 4.
- Abdominal compartment syndrome (ACS) can cause decreased perfusion of the kidneys and abdominal viscera, which may contribute to abdominal wall blanching 2, 5.
Related Factors
Several factors are associated with the development of IAH and ACS, which may indirectly contribute to abdominal wall blanching:
- Brisk volume resuscitation and volume overload are common contributors to the development of IAH 5.
- Space-filling lesions in the abdomen, such as ascites or a hematoma, can lead to increased intra-abdominal pressure (IAP) and ACS 2.
- Abdominal examination is an unreliable predictor of intra-abdominal pressure (IAP), but IAP can be easily measured by simple bedside techniques 5.
Management and Treatment
The management and treatment of IAH and ACS focus on reducing intra-abdominal pressure and improving perfusion:
- Nonoperative medical management strategies, such as improvement of abdominal wall compliance, evacuation of intraluminal contents, and optimization of systemic and regional perfusion, can help reduce elevated IAP 3, 4.
- Surgical intervention, including open abdominal decompression, may be necessary in cases of progressive IAH, end-organ dysfunction, and failure refractory to nonoperative therapies 3, 6.