Abdominal compartment syndrome in children: Experience with three cases

doi:10.1053/jpsu.2000.6857

Journal of Pediatric Surgery

Volume 35, Issue 6, June 2000, Pages 840-842

Presented at the 1999 Annual Meeting of the Section on Surgery of the American Academy of Pediatrics, Washington, DC, October 8-10, 1999.

https://doi.org/10.1053/jpsu.2000.6857 Get rights and content

Abstract

Background/Purpose: Abdominal compartment syndrome (ACS) is defined as cardiopulmonary or renal dysfunction caused by an acute increase in intraabdominal pressure. Although the condition is well described in adults, particularly trauma patients, little is known about ACS in children. Methods: Three girls, ages 4, 5, and 5 years, were treated for ACS by silo decompression. Each child presented in profound shock, required massive fluid resuscitation, and had tremendous abdominal distension. The first child sustained a thoracoabdominal crush injury, underwent immediate celiotomy for splenic avulsion and a liver laceration, and required decompression 5 hours postoperatively. The second underwent ligation of her bluntly transected inferior vena cava; because of massive edema, her abdominal wall could not be closed, and prophylactic decompression had to be performed. The third presented with shock of unknown etiology, and ACS developed acutely with a bladder pressure of 26 mm Hg. Results: Respiratory, renal, and hemodynamic function improved immediately in all 3 patients after decompression. Subsequently, each child underwent abdominal wall reconstruction and recovered uneventfully. Conclusions: ACS is a potentially lethal complication of severe trauma and shock in children. To prevent the development of renal or cardiopulmonary failure in these patients, decompression should be considered for acute, tense abdominal distension. J Pediatr Surg 35:840-842. Copyright © 2000 by W.B. Saunders Company.

Section snippets

Case 1

A 15-kg, 4-year-old girl was pinned under the front tire of a van and sustained a thoracoabdominal crush injury. She was intubated, and chest tubes were placed for bilateral pneumothoraces. Because of hemodynamic instability and a grossly positive diagnostic peritoneal lavage, emergency laparotomy was performed, with the findings of splenic avulsion and a liver laceration. The spleen could not be salvaged; the liver laceration was repaired. Other injuries included femur and clavicle fractures.

Discussion

The adverse effects of increased intraabdominal pressure were first described in the 1800s, but it was not recognized as a significant clinical problem among general surgery patients until the 1980s.¹⁵ Because of improvements in critical care, trauma management, and surgery, more and more critically ill patients are surviving the initial resuscitation, but this resuscitation is complicated potentially by intraabdominal hypertension. The term intraabdominal compartment syndrome, now called

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Citation Excerpt :
The WSACS suggested a wide range of risk factors that predisposes patients to IAH and ACS based on four major pathophysiological categories [3]. Some conditions that are considered more specific to pediatric patients include: 1) diminished abdominal wall compliance- such as congenital abdominal wall defects [49,50], abdominal circumferential burn, and abdominal surgery with tight closure; 2) increased intra-luminal contents- for example, fecal impaction or accumulation of gas, stool or fluid in the intestines as it can be seen in Hirschsprung disease or toxic megacolon; 3) increased abdominal contents- for example, ascites, splenomegaly, hepatomegaly, intra-abdominal tumors, post kidney transplant from an adult donor [51] and, post intestinal and/or liver transplant [52,53]; and 4) capillary leak, and excessive fluid resuscitation [27-30,54]. Conditions reported to be associated with IAH/ACS in children are listed in Table 3.
To consolidate pediatric intensivists' understanding of the pathophysiology, definition, incidence, monitoring, and management of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS); and to highlight the characteristics related to the pediatric population.
This is a narrative review article that utilized a systematic search of the medical literature published in the English language between January 1990 and august 2016. Studies were identified by conducting a comprehensive search of Pub Med databases. Search terms included “intra-abdominal hypertension and child”, “intra-abdominal hypertension and pediatrics”, “abdominal compartment syndrome and child”, and “abdominal compartment syndrome and pediatrics”.
Intra-abdominal hypertension and ACS are associated with a number of pathophysiological disturbances and increased morbidity and mortality. These conditions have been well described in critically ill adults. In children, the IAH and the ACS have a reported incidence of 13% and 0.6 to 10% respectively; they carry similar prognostic impact but are still under-diagnosed and under-recognized by pediatric health care providers.
Intra-abdominal hypertension and ACS are conditions that are regularly encountered in critically ill children. They are associated with an increased morbidity and mortality. Early recognition, prevention and timely management of this critical condition are necessary to improve its outcome.
Abdominal Compartment Syndrome in a Pediatric Patient with Cloacal Exstrophy
2016, Urology
We present a rare complication of abdominal compartment syndrome (ACS) in a child undergoing complex urologic reconstruction. A 10-year-old female born with the abdominal wall defect cloacal exstrophy who had previously undergone multiple abdominal procedures then developed findings consistent with ACS following a complex Mitrofanoff procedure. Although intravesical pressures were not documented because of the nature of her reconstruction, her ACS-type findings were (1) abdominal pain, (2) melena, (3) pulmonary hypoinflation, (4) renal insufficiency, (5) tachycardia, and (6) segmental ischemic small bowel. Management consisted of abdominal decompression, segmental bowel resections, and wound vacuum-assisted-closure management. Patient was eventually discharged home.
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Abdominal compartment syndrome with increased abdominal pressure resulted in multi-organ dysfunctions can be lethal in children. The open abdomen procedure intentionally leaves the abdominal cavity open in patients with severe abdominal sepsis and abdominal compartment syndrome by temporarily relieving the abdominal pressure. We reported our experience of open abdomen procedure in successfully treating a 4-year old boy with abdominal compartment syndrome caused by severe fungal peritonitis and sepsis after gastric perforation.
Incidence and prognosis of intraabdominal hypertension and abdominal compartment syndrome in children
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Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with high mortality rates in children (40–60%). However, literature lacks comprehensive series in childhood. In this study, we aimed to determine the incidences of IAH and ACS, to identify high risk disorders for the development of IAH/ACS and to decrease ACS-associated mortality by early diagnosis and timely intervention.
A prospective study was performed between December 2009 and October 2010 in our institution. IAH was defined by a sustained or repeated pathological elevation in IAP ≥ 12 mmHg without a new organ failure. ACS was identified as a sustained IAP > 15 mmHg with a new organ dysfunction/failure. After recognition of IAH or ACS, patients underwent prompt decompressive interventions as medical or surgical procedures.
150 patients were enrolled to the study (86 M, 64 F). The incidences of IAH and ACS were 9% and 4%, respectively. High risk disorders were trauma, ileus, necrotizing enterocolitis, abdominal wall defects, diaphragmatic hernia and septic shock with massive fluid resuscitation. 14 patients with IAH were treated and mean IAP was decreased from 13.9 ± 1.9 mmHg to 9.2 ± 2.1 mmHg (p < 0.001). None of them progressed to ACS. Six patients with ACS underwent decompressive laparotomy. Mean IAP decreased significantly from 20 ± 3 mmHg to 9 ± 1.4 mmHg (p = 0.001). Vital signs like mean urine output, abdominal perfusion pressure (APP) and respiratory rate were significantly improved after surgery (p < 0.05). ACS-associated mortality rate was determined as 16%.
IAH or ACS was occurred in nearly one tenth of patients admitted to neonatal and pediatric intensive care units. High clinical suspect must be drawn on to recognize and treat these clinical complications more efficiently. Regular and frequent IAP measurement in high risk disorders is essential for early diagnosis. Lower mortality rates can be achieved by early recognition and timely intervention in children.

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^☆: Address reprint requests to James M. DeCou, MD, Department of Pediatric Surgery, The Children's Hospital of Greenville Hospital System, 890 W Faris Rd, Suite 440, Greenville, SC 29605-4253.

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Abdominal compartment syndrome in children: Experience with three cases☆

Abstract

Section snippets

Case 1

Discussion

Surg Clin North Am

Surg Clin North Am

Surg Clin North Am

Am J Surg

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg

J Pediatr Surg