Abdominal compartment syndrome and decompressive laparotomy in children: a 9-year single-center experience
Anthony di Natale1, Ueli Moehrlen2, Hannah Rachel Neeser2
1Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland. anthony.dinatale@kispi.uzh.ch.
Insights
Pediatric abdominal compartment syndrome (ACS) requires prompt decompressive laparotomy (DL) for survival. Early diagnosis and intervention are crucial, as risk factors like young age and elevated lactate increase mortality risk.
Area of Science:
- Pediatric Surgery
- Critical Care Medicine
- Abdominal Compartment Syndrome
Background:
- Abdominal compartment syndrome (ACS) in children is a life-threatening condition with 100% mortality if untreated.
- Decompressive laparotomy (DL) is the definitive treatment for pediatric ACS when conservative measures fail.
Purpose of the Study:
- To determine the incidence of ACS in pediatric patients undergoing emergency laparotomy (EL).
- To evaluate the impact of DL on clinical and laboratory parameters in pediatric ACS.
- To identify variables associated with mortality in pediatric ACS.
Main Methods:
- Retrospective study of 418 children (≤16 years) undergoing EL from 2010-2018.
- ACS diagnosis based on the World Society of the Abdominal Compartment Syndrome guidelines.
- Analysis of clinical and laboratory data, including intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP).
Main Results:
- Fourteen patients (3.3%) underwent emergency DL for ACS.
- DL decreased IAP and increased APP by an average of 60%.
- Mortality rate was 57% (8/14 patients).
- Factors associated with increased mortality risk included age <1 year, weight <3rd percentile, open abdomen, intestinal resection, and serum lactate >1.8 mmol/L.
Conclusions:
- Improving outcomes in pediatric ACS is challenging due to complex risk factors.
- Early diagnosis and timely DL are critical for improving survival rates in pediatric ACS.
Purpose:
Abdominal compartment syndrome (ACS) in children results in 100% mortality if left untreated. Decompressive laparotomy (DL) is the only effective treatment if conservative medical therapies have failed. This study aims to determine the incidence of ACS among pediatric patients who underwent an emergency laparotomy (EL), to describe the effect of DL on clinical and laboratory parameters and, to make a better prediction on fatal outcome, to analyze variables and their association with mortality.
Methods:
This retrospective study includes 418 children up to the age of 16 years who underwent EL between January 2010 and December 2018 at our tertiary pediatric referral center. ACS was defined according to the latest guidelines of the World Society of the Abdominal Compartment Syndrome.
Results:
Fourteen patients had emergency DL for ACS. 6 h preoperatively; median intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) were 22.5 mmHg and 29 mmHg, respectively. After DL, IAP decreased and APP increased, both by an average of 60%. Six patients survived, eight patients had a fatal outcome, resulting in a mortality of 57%. An age under 1 year, weight under the 3rd percentile, an open abdomen treatment, an intestinal resection and an elevated serum lactate > 1.8 mmol/L were associated with an increased relative risk of death.
Conclusions:
Improving the outcome in pediatric patients with ACS by removing or attenuating risk factors is difficult. This emphasizes the need for early diagnosis and prompt DL once the diagnosis of ACS is made.
