An Extreme Case of Lethal Abdominal Compartment Syndrome in Pediatric Patient With Synovial Sarcoma

There is a relative paucity of literature on abdominal compartment syndrome (ACS) in children compared to adults and even less describing ACS in pediatric oncologic patients. We present this case of ACS in a 14-year-old patient to highlight the acuity of lethal consequences despite swift adequate management. Our patient is a 14-year-old male with a history of non-verbal autism and large synovial sarcoma of the left chest wall. He was admitted for scheduled inpatient chemotherapy and radiation. On day 3 of admission, the patient's clinical condition rapidly deteriorated, and a surgical abdomen was found on the exam. In the operating room (OR), massive gaseous distention of the stomach, small intestines, and colon were noted. A loop of small bowel was under such high pressure that the force of evisceration sheared the bowel from the associated mesentery. Due to the severity of the dilated bowel loops, we could not return the eviscerated bowel back inside the abdomen, which led us to leave the Abthera wound vac as sole coverage. The patient was transferred to the PICU, and medical treatment was aimed toward palliative care. The patient passed away three hours later. This case illustrates the acute and lethal nature of ACS in a less studied population, the pediatric oncologic patient. Prompt detection and treatment of ACS are essential for the management of critically ill pediatric patients, especially in those with space occupying tumors within the abdominal cavity. However, extreme presentations of ACS can have lethal consequences despite swift surgical intervention and adequate management.