Abdominal compartment syndrome and decompressive laparotomy in children: a 9-year single-center experience
| Autor: | Anthony di Natale, Noemi Zweifel, Sasha J. Tharakan, Ueli Moehrlen, Hannah Rachel Neeser, Martin Meuli, Andrea A. Mauracher, Barbara Brotschi |
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| Přispěvatelé: | University of Zurich, di Natale, Anthony |
| Jazyk: | němčina |
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Abdominal compartment syndrome medicine.medical_treatment 610 Medicine & health Single Center 03 medical and health sciences 0302 clinical medicine Risk Factors 030225 pediatrics Laparotomy Pediatric surgery medicine Humans 10220 Clinic for Surgery 2735 Pediatrics Perinatology and Child Health Retrospective Studies business.industry Incidence Incidence (epidemiology) Infant Retrospective cohort study General Medicine Decompression Surgical medicine.disease Surgery 2746 Surgery Treatment Outcome 10036 Medical Clinic Child Preschool Relative risk Pediatrics Perinatology and Child Health Female 030211 gastroenterology & hepatology Intra-Abdominal Hypertension Emergency Service Hospital business Perfusion Switzerland |
| DOI: | 10.5167/uzh-194198 |
| Popis: | 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. 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. 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. 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. |
| Databáze: | OpenAIRE |
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