title: A rare case of abdominal compartment syndrome following repair of large myelomeningocele.
abstract: Abdominal compartment syndrome is a rare entity that can be life-threatening if not diagnosed and correctly managed in time. We report a case of abdominal compartment syndrome following an apparently uneventful excision and repair of myelomeningocele (MMC). Though MMC is the most complex congenital spinal cord malformation compatible with life and early surgery is recommended to decrease the risk of meningitis and sepsis but generally surgery is safe without major perioperative turbulence. The majority of the skin defects following excision of MMC are repaired by primary skin closure, but large defects may require secondary closure by skin grafts or rotational flaps. We report a case of an infant with large MMC, who developed abdominal compartment syndrome following excision and repair of the swelling. Intraoperatively, it manifested as bradycardia, hypotension, and ventilatory difficulty which were managed successfully. Subsequently, in the postoperative period, the presence of tight abdomen and fall in urine output raised strong suspicion regarding development of abdominal compartment syndrome. Condition of infant improved following the release of flap sutures. A high index of suspicion along with early management is imperative for a successful outcome in such cases.
authors.affiliation: Department of Neuroanaesthesiology, All Institute of Medical Sciences, New Delhi, India.
authors.forename: Rajendra Singh
authors.initials: RS
authors.lastname: Chouhan
authors.affiliation: Department of Neuroanaesthesiology, All Institute of Medical Sciences, New Delhi, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Bindra
authors.affiliation: Department of Neuroanaesthesiology, All Institute of Medical Sciences, New Delhi, India.
authors.forename: Nitasha
authors.initials: N
authors.lastname: Mishra
authors.affiliation: Department of Neuroanaesthesiology, All Institute of Medical Sciences, New Delhi, India.
authors.forename: Neha
authors.initials: N
authors.lastname: Hasija
authors.affiliation: Department of Neurosurgery, All Institute of Medical Sciences, New Delhi, India.
authors.forename: Sumit
authors.initials: S
authors.lastname: Sinha
keywords: Abdominal compartment syndrome; flap; infant; large myelomeningocele