No abstract

Background and aims: Intra-abdominal hypertension, identified as an independent risk factor for death, leads to Abdominal Compartment Syndrome (ACS), which might be involved in the dysfunction of gastrointestinal tracts, respiratory system, cardiovascular system, renal system, and cerebrum. Aims: To compare the survival rates of between volume-controlled percutaneous catheter drainage (PCD) and non-PCD in children with massive ascites resulted from ACS. Methods: We conducted a comparative series case-study in 18 children with ACS treated in a university hospital southern China from April 2011 to June 2013. Patients with ACS were identified by intravesical pressure over 10 mmHg with evidence of newly-onset of organ dysfunction or failure. Massive ascites were revealed by ultrasonography and drained by PCD after ultrasound localization. Results: Of these 18 enrolled children, 11were treated with PCD, and 7 were treated without PCD. The etiology of these children included abdominal tumor (56%), capillary leak of post-operation of liver or kidney transplantation (17%), cirrhosis (17%) and urinary ascites (11%). For ACS, gastrointestinal tracts and pulmonary were the most frequently affected organs, while the cerebrum was the least involved. High intra-abdominal pressure (IAP) was closely associated with high mortality. Treatment with PCD significantly decreased IAP, abdominal circumference, and the number of organ dysfunction. PCD treatment also significantly reduced the mortality from 100% to 18.2%. However, we also found that as the complications of PCD, abdominal infection (9%)and electrolyte imbalance(9%)occasionally occurred. Conclusions: Controlled peritoneal drainage, a minimally invasive and safe decompression, is effective in patients with ACS and should be considered in children with massive ascites.