title: Emergent abdominal decompression with patch abdominoplasty in the pediatric patient.
abstract: OBJECTIVE
  Abdominal compartment syndrome (ACS) is the cardiac, pulmonary, and renal dysfunction that occurs as a result of elevated intraabdominal pressure. The authors present their experience with patch abdominoplasty (PA) in pediatric patients as a means to treat and prevent ACS.
  
  
  METHODS
  The charts of patients who underwent PA were reviewed retrospectively. ACS was defined as the increased oxygen requirements and elevation of peak inspiratory pressures (PIP) associated with abdominal distension and worsening renal and or cardiac function.
  
  
  RESULTS
  A total of 23 patients (13 boys) were treated (average age, 23 months). Diagnoses included necrotizing enterocolitis (NEC, n = 13), trauma (n = 3), Hirschsprung's enterocolitis (n = 2), perforated bowel (n = 4), and bilateral Wilms' tumor with bowel obstruction (n = 1). Oxygen requirements decreased after patch abdominoplasty (mean preoperative FIO2, 0.87 +/- 24, mean postoperative, 0.67 +/- 24 [P = .01]). The PIP decreased significantly in the 13 patients who survived (mean preoperative PIP, 33 +/- 8, mean postoperative PIP, 27 +/- 7 [P = .01]). These PIPs failed to respond in the 8 nonsurvivors (mean preoperative PIP, 35 +/- 10, mean postoperative PIP, 33 +/- 14 [P value not significant]). Six of the 8 nonsurvivors had NEC. Complications of intraabdominal abscess and enterocutaneous fistula were seen in 5 patients, all of who had NEC.
  
  
  CONCLUSIONS
  Patch abdominoplasty effectively decreases airway pressures and oxygen requirements associated with ACS. Complications with PA occur primarily in patients with NEC. Failure to respond with a decrease in PIP and FIO2 requirements is an ominous sign.
authors.affiliation: Department of Surgery, University of Texas-Houston Medical School and the Memorial-Hermann Children's Hospital, USA.
authors.forename: H L
authors.initials: HL
authors.lastname: Neville
authors.forename: K P
authors.initials: KP
authors.lastname: Lally
authors.forename: C S
authors.initials: CS
authors.lastname: Cox
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology / Q000601:surgery*; D000009:Abdominal Muscles / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003161:Compartment Syndromes / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods* / Q000401:mortality; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013526:Surgical Mesh; D015996:Survival Rate; D016896:Treatment Outcome