title: Decompressive laparotomy for refractory intracranial hypertension after traumatic brain injury.
abstract: BACKGROUND
  Intracranial hypertension is a crucial modifiable risk factor for poor outcome after traumatic brain injury (TBI). Limited evidence suggests that decompressive laparotomy may be an effective treatment for refractory ICH in patients who have elevated intra-abdominal pressure.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  We present a multi-trauma patient who sustained severe TBI in a motor vehicle collision. Intracranial pressure (ICP) was initially medically managed but became refractory to standard therapies. Emergent decompressive laparotomy performed in the surgical intensive care unit for abdominal compartment syndrome concomitantly improved the patient's ICP.
  
  
  CONCLUSIONS
  Elevated intra-abdominal pressure can exacerbate intracranial hypertension in patients with TBI. Recognition of this condition and treatment with decompressive laparotomy may be useful in patients with intracranial hypertension refractory to optimal medical therapy.
authors.affiliation: Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Dorfman
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Burns
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Green
authors.forename: Christina
authors.initials: C
authors.lastname: DeFusco
authors.forename: Suresh
authors.initials: S
authors.lastname: Agarwal
mesh_terms: D018806:APACHE; D000063:Accidents, Traffic; D000203:Activities of Daily Living / Q000145:classification; D000293:Adolescent; D001929:Brain Edema / Q000175:diagnosis / Q000601:surgery; D001930:Brain Injuries / Q000175:diagnosis / Q000601:surgery*; D003131:Combined Modality Therapy; D003299:Cooperative Behavior; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D046648:Hematoma, Subdural, Intracranial / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D033183:Interdisciplinary Communication; D059325:Intra-Abdominal Hypertension / Q000175:diagnosis / Q000601:surgery*; D019586:Intracranial Hypertension / Q000601:surgery*; D007427:Intracranial Pressure / Q000502:physiology; D007813:Laparotomy / Q000379:methods*; D008353:Mannitol / Q000008:administration & dosage; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers
chemical_list: D008353:Mannitol