Abdominal compartment syndrome and decompressive laparotomy in children: a 9-year single-center experience.
- di Natale A Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland. anthony.dinatale@kispi.uzh.ch.
- Moehrlen U Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
- Neeser HR Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
- Zweifel N Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
- Meuli M Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
- Mauracher AA Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland.
- Brotschi B Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland.
- Tharakan SJ Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
- 2020-03-01
Published in:
- Pediatric surgery international. - 2020
Abdominal compartment syndrome
Abdominal perfusion pressure
Decompressive laparotomy
Intra-abdominal pressure
Pediatrics
Child, Preschool
Decompression, Surgical
Emergency Service, Hospital
Female
Humans
Incidence
Infant
Intra-Abdominal Hypertension
Laparotomy
Male
Retrospective Studies
Risk Factors
Switzerland
Treatment Outcome
English
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.
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.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1007/s00383-020-04632-0
- PMID 32112129
- Persistent URL
- https://sonar.ch/global/documents/258474
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