Outcomes in pediatric patients with abdominal compartment syndrome following urgent exploratory laparotomy.
OBJECTIVE
Abdominal compartment syndrome (ACS) is a serious condition with high mortality in critically ill children. Our objectives were to characterize the incidence of ACS in pediatric patients who underwent urgent exploratory laparotomy and to compare outcomes of patients with and without ACS.


METHODS
This retrospective review examined pediatric patients (0-18years) who underwent urgent exploratory laparotomy over a 2-year period. Primary outcome was mortality; secondary outcomes were achievement of primary fascial closure and necessity of bowel resection.


RESULTS
One hundred nineteen patients were included, of which 33 (28%) had ACS, with 27 (23%) being primary ACS and 6 (5%) secondary ACS. Twenty-eight-day mortality was higher in the ACS versus non-ACS group (52% versus 0%, p<0.001) and overall hospitalization (64% versus 2%, p<0.001). Primary fascial closure was achieved less often in ACS compared to non-ACS patients (46% versus 98%, p<0.001). Bowel resection was more frequent in ACS versus non-ACS patients, approaching statistical significance (49% versus 30%, p 0.056).


CONCLUSIONS
During the study period, almost one third of children who underwent urgent exploratory laparotomy had ACS and 64% died. Children undergoing evaluation for acute surgical abdomen may benefit from routine intraabdominal pressure measurement.


METHODS
Level III retrospective comparative study.
Division of Critical Care, Department of Pediatrics, Loma Linda University Children's Hospital, 11175 Campus Street, Suite A1117, Loma Linda, CA, United States.
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Thomas
Division of Critical Care, Department of Pediatrics, Loma Linda University Children's Hospital, 11175 Campus Street, Suite A1117, Loma Linda, CA, United States.
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Kriplani
School of Medicine, Loma Linda University, Loma Linda, CA, United States.
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Crane
School of Medicine, Loma Linda University, Loma Linda, CA, United States.
S O
SO
Dehom
Division of Critical Care, Department of Pediatrics, Loma Linda University Children's Hospital, 11175 Campus Street, Suite A1117, Loma Linda, CA, United States.
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Oei
Department of Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, United States.
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J
Baerg
Nutritional Services, Loma Linda Children's Hospital, Loma Linda, CA, United States.
C
C
Wright
Nutritional Services, Loma Linda Children's Hospital, Loma Linda, CA, United States.
Y
Y
Xu
Division of Critical Care, Department of Pediatrics, Loma Linda University Children's Hospital, 11175 Campus Street, Suite A1117, Loma Linda, CA, United States. Electronic address: jejike@llu.edu.
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JC
Ejike
D000005:Abdomen / Q000601:surgery; D000006:Abdomen, Acute / Q000601:surgery*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D059325:Intra-Abdominal Hypertension / Q000209:etiology*; D007813:Laparotomy / Q000009:adverse effects*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
Abdominal compartment syndrome; Children; Exploratory laparotomy; Intraabdominal hypertension