Abdominal complications after severe burns

Abdominal catastrophe in the severely burned patient without abdominal injury has been described. We perceived an alarming recent incidence of this complication in our burn center, both during acute resuscitation and later in the hospital course. We sought to define incidence, outcomes, and associated factors, such as excessive resuscitation volume and treatment issues.

We examined all severely burned military and civilian patients with abdominal pathology between March 2003 and February 2008. Data included age, gender, total body surface area burn, inhalation injury, Injury Severity Score, disposition, resuscitation volume, time from injury to diagnosis, use of recombinant factor VIIa, vasopressors, and early tube feedings. We assembled a Delphi panel of surgeons experienced in abdominal catastrophes to review these data.

Among 1,825 patients admitted to the US Army Institute of Surgical Research Burn Center, 120 (6.6%) were diagnosed with abdominal pathology (burn size 48% +/- 19%), of which 51 (2.8%) had abdominal catastrophe. The majority of these occurred in the first days after injury with associated abdominal compartment syndrome (32 of 51) and increased linearly to burn size. We noted another group of patients who presented primarily with ischemic bowel later in the course, with the same clinical presentation. Resuscitation volume was 6.02 mL/kg/percent total body surface area burned. Vasopressors were used in 71% of patients and tube feedings in 57% before diagnosis.

Abdominal catastrophe without abdominal trauma occurs in 2.8% of our population. Associated mortality was 78% without obvious cause. Delphi panel experts recommended more aggressive monitoring of abdominal compartment pressures and earlier operative management to improve outcomes.