Das akute Abdomen auf der Intensivstation

Das akute Abdomen ist stets ein Notfall und erfordert eine umgehende Abklärung. Gefragt ist insbesondere eine enge interdisziplinäre Zusammenarbeit zwischen Intensivpflegekräften, Anästhesisten, Chirurgen, Radiologen und Mikrobiologen.

Kernaussagen

• Die Diagnose und die Therapie der Sepsis erfordert eine intensive und interdisziplinäre Zusammenarbeit zwischen Intensivpflege, Anästhesisten, Chirurgen, Radiologen und Mikrobiologen.

• Das akute Abdomen in der Intensivtherapie erfordert zwingend eine unverzügliche Diagnostik und falls notwendig eine chirurgische Sanierung.

• Bei Anzeichen einer Sepsis muss man frühzeitig mit der leitliniengerechten, antibiotischen und hämodynamischen Therapie beginnen. Patienten mit persistierend hohen postoperativen laborchemischen Entzündungswerten oder steigenden Entzündungswerten unter antibiotischer Therapie sollten frühzeitig einer Ursachendiagnostik mit Bildgebung (CT und Sonografie) und ggf. Exploration unterzogen werden.

• Die sekundäre Peritonitis ist eine häufige Ursache der Sepsis bei chirurgischen Patienten. Zuerst sollte man daher operationsbedingte Komplikationen ausschließen. Hierzu ist eine frühzeitige interdisziplinäre Kommunikation mit den beteiligten Chirurgen zur Fokussuche und Fokussanierung dringend gefordert.

• Die chirurgische Therapie zielt auf eine definitive Beseitigung der Sepsisursache mit primärem Bauchdeckenverschluss ab. Postoperativ ist der Patient auf ein abdominelles Kompartmentsyndrom oder eine persistierende Sepsis und Peritonitis zu überwachen. Mögliche Folge-Laparotomien und Re-Explorationen müssen frühzeitig eingeleitet werden.

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