Abdominal Compartment Syndrome in Children: Clinical and Imaging Features

The objective of our study was to identify the clinical features and imaging findings of abdominal compartment syndrome (ACS) in children.

During the study period, ACS was diagnosed in 50 children, 14 of whom underwent CT or MRI. We reviewed the medical records of the 50 children to obtain clinical information, such as underlying risk factors, therapeutic approach, and clinical outcome, and we evaluated the CT and MRI examinations of the 14 children. We compared the imaging features of the 14 children with ACS with those of 14 age-matched control subjects who had abdominal distention without ACS.

The most common risk factor of pediatric ACS was increased abdominal contents, particularly bowel dilatation. Among the 50 children, 38 underwent decompressive intervention. The mortality rate was 45% in the group who underwent decompression versus 58% in the group who did not undergo decompression intervention. From a review of the CT and MR images of the 14 patients with these examinations, we found that the most common findings were ascites (86%), basal lung atelectasis (69%), inferior vena cava (IVC) compression (50%), and abnormal enhancement of bowel wall (64%). Compared with the control subjects, the study group with ACS had the following suggestive imaging features: IVC compression (p = 0.001), basal lung atelectasis (p = 0.006), heterogeneous perfusion of the kidneys (p = 0.026), ascites (p = 0.043), and subcutaneous edema (p = 0.053). However, the ratio of maximal anteroposterior-to-transverse abdominal diameter (AT ratio) was not significant (p = 0.565).

A well-known CT finding for ACS, an increased AT ratio, proved not specific for ACS in pediatric patients; rather, IVC compression, basal lung atelectasis, compromised renal perfusion, and ascites should raise suspicion for ACS in children.