Paediatric abdominal compartment syndrome in a 4.6 kg infant

An infant with a history of intestinal atresia type IV repaired at birth presented to the emergency department with recurrent abdominal distension. She was admitted 1 month before for abdominal distension secondary to formula intolerance. Hypothermia and mild respiratory distress prompted an evaluation with imaging, laboratory investigations, and blood and urine cultures. She was admitted to the intensive care unit and management included immediate surgical consultation, nothing by mouth, nasogastric tube placement for decompression and initiation of intravenous fluids and antibiotics. Her clinical status deteriorated within hours, requiring intubation and initiation of pressors. She responded to resuscitation but developed signs of abdominal compartment syndrome (ACS), prompting surgical decompression. The patient had a prolonged hospital stay and was discharged with total parenteral nutrition and G-tube feeds. This case highlights the importance of prompt recognition of risk factors, symptoms and management of paediatric ACS facilitating a reduction in morbidity and mortality.