Abdominal compartment syndrome in childhood: diagnostics, therapy and survival rate

The abdominal compartment syndrome (ACS) in childhood is a rare but dire disease if diagnosed delayed and treated improperly. The mortality amounts up to 60% (Beck et al. in Pediatr Crit Care Med 2:51-56, 2001). ACS is defined by a sustained rise of the intraabdominal pressure (IAP) together with newly developed organ dysfunction. The present study reports on 28 children with ACS to evaluate its potential role in the diagnosis, treatment and outcome of ACS.

Retrospectively, medical reports and outcome of 28 children were evaluated who underwent surgical treatment for ACS. The diagnosis of ACS was established by clinical signs, intravesical pressure-measurements and concurrent organ dysfunction.

Primary ACS was found in 25 children (89.3%) predominantly resulting from polytrauma and peritonitis. Three children presented secondary ACS with sepsis (2 cases) and combustion (1 case) being the underlying causative diseases. Therapy of choice was the decompression of the abdominal cavity with implantation of an absorbable Vicryl(®) mesh. In 18 cases the abdominal cavity could be closed later, while in the other ten cases granulation of the mesh was allowed. The overall survival rate was 78.6% (22 of 28 children). The cause of death in the remaining six cases (21.4%) was sepsis with multiorgan failure.

Our results suggest that early establishment of the specific diagnosis of ACS followed by swift therapy with reduction of intraabdominal hypertension is essential in order to further reduce the high mortality rate associated with this condition.