Abdominal Compartment Syndrome in a Pediatric Patient With Cloacal Exstrophy

Area of Science:

• Pediatric Surgery
• Urology
• Critical Care Medicine

Background:

• Cloacal exstrophy is a rare congenital anomaly requiring complex surgical management.
• Abdominal compartment syndrome (ACS) is a life-threatening condition characterized by increased intra-abdominal pressure.
• Urologic reconstruction, particularly in patients with complex abdominal wall defects, carries a risk of ACS.

Observation:

• A 10-year-old female with a history of cloacal exstrophy and multiple prior abdominal surgeries developed ACS post-Mitrofanoff procedure.
• Clinical signs of ACS included abdominal pain, melena, pulmonary hypoinflation, renal insufficiency, tachycardia, and segmental ischemic small bowel.
• Intravesical pressures were not directly measured due to the reconstructive approach.

Findings:

• The patient presented with a constellation of symptoms indicative of ACS.
• Management involved immediate abdominal decompression, surgical resection of ischemic bowel segments, and wound vacuum-assisted closure.
• Successful recovery and discharge were achieved following multidisciplinary intervention.

Implications:

• This case underscores the importance of recognizing and promptly managing ACS in pediatric surgical patients, even with complex anatomy.
• Early diagnosis and intervention are critical for improving outcomes in pediatric ACS.
• Complex urologic reconstructions in patients with abdominal wall defects necessitate vigilant monitoring for potential complications like ACS.