Hepatosplanchnic perfusion changes following isolated abdominal trauma and surgery: A scoping review of evidence dominated by pneumoperitoneum models

Abstract

The hepatosplanchnic vascular response to isolated abdominal organ injury remains poorly defined. The aim of this review was to synthesize the available evidence on macrovascular hepatosplanchnic flow and organ‐specific microvascular perfusion following isolated abdominal injury or surgery. PubMed/MEDLINE was searched through 11 May 2026 for human and animal studies reporting visceral hemodynamic changes after abdominal trauma, experimental injury, or surgery. Systematic‐review methods included structured study selection, data extraction, and design‐specific risk‐of‐bias assessment within a PRISMA‐based scoping‐review framework. Owing to heterogeneity, findings were synthesized narratively. Twenty‐six studies were included: 14 human and 12 animal studies. Nineteen investigated pneumoperitoneum or elevated intra‐abdominal pressure, four major abdominal surgery, and three other models. Perfusion reductions became more frequent with increasing pressure and were significantly more common at >15 than <10 mmHg ( p  = 0.031). Higher pressures also impaired compensatory mechanisms, including the hepatic arterial buffer response. After major surgery, portal and total hepatosplanchnic flow generally increased early postoperatively, while gastric mucosal perfusion deteriorated, indicating macro–microcirculatory dissociation. Only one study directly examined primary intra‐abdominal injury and assessed microcirculation alone. Evidence remains indirect, heterogeneous, and methodologically limited. Studies combining serial macrovascular and organ‐specific microvascular measurements are required to define the hepatosplanchnic response.