Description: Abdominal distension, an increase in abdominal size upon inspection, may indicate increased abdominal volume and bowel distension [1]. Abdominal distension is a non-specific sign. It is impossible to measure in the obese patients and clinical relevance is dependent upon accompanying signs and symptoms [2]. Abdominal distension has been associated with increased intra-abdominal pressure [3].
Feasibility/Equipment: Abdominal distension is a clinical sign that can be assessed bed-side. Abdominal circumference can be measured using a measuring tape. Differential diagnosis including identification of bowel distension as a cause of abdominal distension requires imaging.
Scoring information: No specific scoring system exists. Distension can be measured using abdominal circumference [4].
Cost: None. Imaging costs for quantification of bowel diameter.
Evidence: Abdominal distension has been evaluated in 2 prospective studies [1, 3]. It has been associated with increased abdominal pressure, which by itself has been associated with organ dysfunction and mortality [5, 6]. It has been assessed as part of the GastroIntestinal Dysfunction Score (GIDS) and is a symptom within the definition of acute gastrointestinal dysfunction [7].
Accuracy / measurement properties: Correlations: correlation with intra-abdominal hypertension (OR 3.191 [95% CI 1.503 – 6.773] [8]. Correlation (multivariable regression analysis) of bowel distension on day 7 with 28-day survival (adjusted OR 7.070 [1.140 to 43.859] [1]. In the GIDS dataset abdominal distension has been associated with 28-day (HR 3.95 (2.35 to 6.64), p < 0.001) as well as 90-day (HR 3.88 (2.43 to 6.20), p < 0.001) mortality [7]. A variable combining abdominal distension and intra-abdominal hypertension was inferior in the GIDS score compared to both used as independent variables.
References
1. Reintam Blaser A, Poeze M, Malbrain ML, Bjorck M, Oudemans-van Straaten HM, Starkopf J, Gastro-Intestinal Failure Trial G: Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study. Intensive Care Med 2013, 39(5):899-909.
2. Reintam Blaser A, Preiser JC, Fruhwald S, Wilmer A, Wernerman J, Benstoem C, Casaer MP, Starkopf J, van Zanten A, Rooyackers O et al: Gastrointestinal dysfunction in the critically ill: a systematic scoping review and research agenda proposed by the Section of Metabolism, Endocrinology and Nutrition of the European Society of Intensive Care Medicine. Crit Care 2020, 24(1):224.
3. Reintam Blaser A, Regli A, De Keulenaer B, Kimball EJ, Starkopf L, Davis WA, Greiffenstein P, Starkopf J, Incidence RF, Outcomes of Intra-Abdominal Study I: Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients-A Prospective Multicenter Study (IROI Study). Crit Care Med 2019, 47(4):535-542.
4. Van Mieghem C, Dens J, Herregods MC, Desmet W: Left ventricular wall hematoma and cardiac tamponade complicating percutaneous coronary intervention using IIb/IIIa receptor antagonists. J Interv Cardiol 2003, 16(5):381-384.
5. Bachmann KF, Regli A, Mandul M, Davis W, Reintam Blaser A, Iroi, i SSI: Impact of intraabdominal hypertension on kidney failure in critically ill patients: A post-hoc database analysis. J Crit Care 2022, 71:154078.
6. Regli A, Reintam Blaser A, De Keulenaer B, Starkopf J, Kimball E, Malbrain M, Van Heerden PV, Davis WA, Investigators IS, Palermo A et al: Intra-abdominal hypertension and hypoxic respiratory failure together predict adverse outcome – A sub-analysis of a prospective cohort. J Crit Care 2021, 64:165-172.
7. Reintam Blaser A, Padar M, Mandul M, Elke G, Engel C, Fischer K, Giabicani M, Gold T, Hess B, Hiesmayr M et al: Development of the Gastrointestinal Dysfunction Score (GIDS) for critically ill patients – A prospective multicenter observational study (iSOFA study). Clin Nutr 2021, 40(8):4932-4940.
8. Blaser AR, Regli A, De Keulenaer B, Kimball EJ, Starkopf L, Davis WA, Greiffenstein P, Starkopf J, Palermo A, Tamme K et al: Incidence, Risk Factors, and Outcomes of Intra-Abdominal Hypertension in Critically Ill Patients-A Prospective Multicenter Study (IROI Study). Critical Care Medicine 2019, 47(4):535-542.