Outcomes in pediatric patients with abdominal compartment syndrome following urgent exploratory laparotomy
S Thomas1, D Kriplani1, C Crane2
1Division of Critical Care, Department of Pediatrics, Loma Linda University Children's Hospital, 11175 Campus Street, Suite A1117, Loma Linda, CA, United States.
Insights
Abdominal compartment syndrome (ACS) in critically ill children undergoing urgent exploratory laparotomy is common, affecting nearly one-third of patients. This condition significantly increases mortality and complications, highlighting the need for routine intraabdominal pressure measurement.
Area of Science:
- Pediatric Surgery
- Critical Care Medicine
- Surgical Outcomes
Background:
- Abdominal compartment syndrome (ACS) is a life-threatening condition in critically ill children.
- High mortality rates are associated with ACS in pediatric intensive care settings.
Purpose of the Study:
- To determine the incidence of ACS in pediatric patients undergoing urgent exploratory laparotomy.
- To compare mortality and surgical outcomes between pediatric patients with and without ACS.
Main Methods:
- Retrospective review of pediatric patients (0-18 years) undergoing urgent exploratory laparotomy over two years.
- Analysis of primary outcome (mortality) and secondary outcomes (fascial closure, bowel resection).
- Study design classified as a Level III retrospective comparative study.
Main Results:
- ACS was present in 28% of 119 pediatric patients (33 patients).
- Twenty-eight-day mortality was significantly higher in the ACS group (52%) compared to the non-ACS group (0%).
- Primary fascial closure was less frequent (46% vs. 98%) and bowel resection more frequent in ACS patients.
Conclusions:
- ACS affects a substantial proportion of pediatric patients undergoing urgent exploratory laparotomy, with a high associated mortality rate (64%).
- Routine intraabdominal pressure measurement may benefit pediatric patients evaluated for acute surgical abdomen.
- Early detection and management of ACS are crucial for improving outcomes in critically ill children.
Background/Purpose:
Abdominal compartment syndrome (ACS) is a serious condition with high mortality in critically ill children. Our objectives were to characterize the incidence of ACS in pediatric patients who underwent urgent exploratory laparotomy and to compare outcomes of patients with and without ACS.
Methods:
This retrospective review examined pediatric patients (0-18years) who underwent urgent exploratory laparotomy over a 2-year period. Primary outcome was mortality; secondary outcomes were achievement of primary fascial closure and necessity of bowel resection.
Results:
One hundred nineteen patients were included, of which 33 (28%) had ACS, with 27 (23%) being primary ACS and 6 (5%) secondary ACS. Twenty-eight-day mortality was higher in the ACS versus non-ACS group (52% versus 0%, p<0.001) and overall hospitalization (64% versus 2%, p<0.001). Primary fascial closure was achieved less often in ACS compared to non-ACS patients (46% versus 98%, p<0.001). Bowel resection was more frequent in ACS versus non-ACS patients, approaching statistical significance (49% versus 30%, p 0.056).
Conclusion:
During the study period, almost one third of children who underwent urgent exploratory laparotomy had ACS and 64% died. Children undergoing evaluation for acute surgical abdomen may benefit from routine intraabdominal pressure measurement.
Level Of Evidence:
Level III retrospective comparative study.
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