Abdominal compartment syndrome in children: experience with three cases
J M DeCou1, R S Abrams, R S Miller
1Department of Pediatric Surgery, The Children's Hospital, Greenville, South Carolina 29605-4253, USA.
Insights
Abdominal compartment syndrome (ACS) in children is a serious condition that can lead to organ failure. Prompt surgical decompression can rapidly improve organ function and prevent fatal outcomes in pediatric patients.
Area of Science:
- Pediatric surgery
- Critical care medicine
- Trauma management
Background:
- Abdominal compartment syndrome (ACS) is characterized by organ dysfunction due to increased intra-abdominal pressure.
- While well-documented in adults, pediatric ACS remains less understood.
- This study focuses on the presentation and management of ACS in pediatric patients.
Observation:
- Three pediatric patients (ages 4-5) presented with severe shock, abdominal distension, and signs of ACS.
- Causes included thoracoabdominal crush injury, inferior vena cava injury with massive edema, and acute shock of unknown etiology.
- Bladder pressures indicated significant intra-abdominal hypertension.
Findings:
- Silo decompression led to immediate improvements in respiratory, renal, and hemodynamic function in all three patients.
- Following decompression, patients underwent abdominal wall reconstruction.
- All patients recovered uneventfully after the intervention.
Implications:
- ACS is a life-threatening complication in pediatric trauma and shock.
- Early recognition and surgical decompression are crucial for preventing renal and cardiopulmonary failure.
- This approach offers a viable strategy for managing pediatric ACS.
Background/Purpose:
Abdominal compartment syndrome (ACS) is defined as cardiopulmonary or renal dysfunction caused by an acute increase in intraabdominal pressure. Although the condition is well described in adults, particularly trauma patients, little is known about ACS in children.
Methods:
Three girls, ages 4, 5, and 5 years, were treated for ACS by silo decompression. Each child presented in profound shock, required massive fluid resuscitation, and had tremendous abdominal distension. The first child sustained a thoracoabdominal crush injury, underwent immediate celiotomy for splenic avulsion and a liver laceration, and required decompression 5 hours postoperatively. The second underwent ligation of her bluntly transected inferior vena cava; because of massive edema, her abdominal wall could not be closed, and prophylactic decompression had to be performed. The third presented with shock of unknown etiology, and ACS developed acutely with a bladder pressure of 26 mm Hg.
Results:
Respiratory, renal, and hemodynamic function improved immediately in all 3 patients after decompression. Subsequently, each child underwent abdominal wall reconstruction and recovered uneventfully.
Conclusions:
ACS is a potentially lethal complication of severe trauma and shock in children. To prevent the development of renal or cardiopulmonary failure in these patients, decompression should be considered for acute, tense abdominal distension.
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