Abdominal Decompression in Children

Ejike, J. Chiaka; Mathur, Mudit

doi:10.1155/2012/180797

Cited by 10 publications

(9 citation statements)

References 69 publications

(87 reference statements)

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“…However, improved survival parameters after surgical decompression are owing to the positive effects on the underlying disease, especially in acute pancreatitis and septic abdomen. [ 27 – 30 ] In our study, DL was not significantly correlated with the mortality rate ( P > 0.05) but was protective (OR <1), reducing mortality by 8.7%.…”

Section: Discussioncontrasting

confidence: 70%

How much does decompressive laparotomy reduce the mortality rate in primary abdominal compartment syndrome?

Mureşan

Mureșan²,

Brînzaniuc³

et al. 2017

Medicine

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Contribution of decompressive laparotomy within the framework of the complex therapeutic algorithm of abdominal compartment syndrome (ACS) is cited with an extremely heterogeneous percentage in terms of survival. The purpose of this study was to present new data regarding contribution of each therapeutic step toward decreasing the mortality of this syndrome.This is a longitudinal prospective study including 134 patients with risk factors for ACS. The intra-abdominal pressure was measured every hour indirectly based on transvesical approach and the appearance of organ dysfunction. Specific therapy for ACS was based on the 2013 World Society of Abdominal Compartment Syndrome guidelines, which include laparotomy decompression. Management of the temporarily open abdomen included an assisted vacuum wound therapy.Of 134 patients, 66 developed ACS. The average intra-abdominal pressure significantly decreased after therapy and decompression surgery. The overall rate of mortality was 27.3% with statistical significance in necrotizing infected pancreatitis. Surgical decompression performed within the first 24 hours after the onset of ACS had a protective role against mortality (odds ratio <1). The average time after which laparotomy decompression was performed was 16.23 hours. The complications occurred during TAC were 2 wound suppurations and 1 intestinal obstruction. Wound suppurations evolved favorably by using vacuum wound-assisted therapy associated with the general treatment, whereas for occlusion, resurgery was performed after which adhesions dissolved. The final closure of the abdomen was performed at a mean of 11.7 days (min. = 9, max. = 14). The closure type was primary suture of the musculoaponeurotic edges in 4 cases, and the use of dual mesh in the other 11 cases.The highest mortality rate in the study group was registered in patients with necrotizing pancreatitis and the lowest in trauma group. Surgical decompression within the framework of the complex algorithm treatment of ACS contributed to the reduction of mortality by 8.7%. It is extremely important that the elapsed time since the initiation of the ACS until the surgical decompression is minimal (under 24 hours).

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Section: Discussioncontrasting

confidence: 70%

How much does decompressive laparotomy reduce the mortality rate in primary abdominal compartment syndrome?

Mureşan

Mureșan²,

Brînzaniuc³

et al. 2017

Medicine

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“…The abdomen was closed 8 days after the decompressive laparotomy, and the patient was discharged to home 11 days after closure, having spent 20 days in hospital. This case is unique in its sudden presentation, which contrasts with other reported cases of ACs in children [9][10][11]. A sudden manifestation of ACs is likely to be preceded by a gradual increase in IAP over a long period of time; the present case gives an archetypical example of this.…”

contrasting

confidence: 51%

A sudden presentation of abdominal compartment syndrome

Berkman¹,

Naftalovich²,

Oydanich³

et al. 2021

ait

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LeTTeRs TO The eDITOR Dear editor, Abdominal compartment syndrome (ACs) is defined as sustained intraabdominal pressure (IAP) exceeding 20 mm hg, which causes end-organ damage due to impaired tissue perfusion, as with other compartment syndromes [1, 2]. This dysfunction can extend beyond the abdomen to other organs like the heart and lungs. ACs is most commonly caused by trauma or surgery to the abdomen. It is characterised by interstitial oedema, which can be exacerbated by large fluid shifts during massive transfusion of blood products and other fluid resuscitation [3]. Normally, IAP is nearly equal to or slightly above ambient pressure. Intra-abdominal hypertension is typically defined as abdominal pressure greater than or equal to 12 mm hg [4]. Initially, the abdomen is able to distend to accommodate the increase in pressure caused by oedema; however, IAP becomes highly sensitive to any additional volume once maximum distension is reached. This is a function of abdominal compliance, which plays a key role in the development and progression of intraabdominal hypertension [5]. surgical decompression is required in severe cases of organ dysfunction-usually when IAPs are refractory to other treatment options [6]. excessive abdominal pressure leads to systemic pathophysiological consequences that may warrant admission to a critical care unit. These include hypoventilation secondary to restriction of the deflection

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“…Normal intra-abdominal pressure (IAP) in neonatal age is about 10 mmHg, whereas intra-abdominal hypertension (IAH) is defined as a sustained rise of IAP > 10 mmHg ( 3 ). ACS is a sustained IAP of >10 mmHg associated with organ dysfunction ( 7 , 8 ). Abdominal perfusion pressure (APP) is more accurate in the evaluation of visceral blood supply and a need for resuscitation.…”

Section: Introductionmentioning

confidence: 99%

High Abdominal Perfusion Pressure Using Umbilical Cord Flap in the Management of Gastroschisis

et al. 2021

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Background: Gastroschisis management remains a controversy. Most surgeons prefer reduction and fascial closure. Others advise staged reduction to avoid a sudden rise in intra-abdominal pressure (IAP). This study aims to evaluate the feasibility of using the umbilical cord as a flap (without skin on the top) for tension-free repair of gastroschisis.Methods: In a prospective study of neonates with gastroschisis repaired between January 2018 to October 2020 in Tanta University Hospital, we used the umbilical cord as a flap after the evacuation of all its blood vessels and suturing the edges of the cord with the skin edges of the defect. They were guided by monitoring abdominal perfusion pressure (APP), peak inspiratory pressure (PIP), central venous pressure (CVP), and urine output during 24 and 48 h postoperatively. The umbilical cord flap is used for tension-free closure of gastroschisis if PIP > 24 mmHg, IAP > 20 cmH2O (15 mmHg), APP <50 mmHg, and CVP > 15cmH2O.Results: In 20 cases that had gastroschisis with a median age of 24 h, we applied the umbilical cord flap in all cases and then purse string (Prolene Zero) with daily tightening till complete closure in seven cases, secondary suturing after 10 days in four cases, and leaving skin creeping until complete closure in nine cases. During the trials of closure, the range of APP was 49–52 mmHg. The range of IAP (IVP) was 15–20 cmH2O (11–15 mmHg), the range of PIP was 22–25 cmH2O, the range of CVP was 13–15 cmH2O, and the range of urine output was 1–1.5 ml/kg/h.Conclusion: The umbilical cord flap is an easy, feasible, and cheap method for tension-free closure of gastroschisis with limiting the PIP ≤ 24 mmHg, IAP ≤ 20 cmH2O (15 mmHg), APP > 50 mmHg, and CVP ≤ 15cmH2O.

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Abdominal Decompression in Children

Cited by 10 publications

References 69 publications

How much does decompressive laparotomy reduce the mortality rate in primary abdominal compartment syndrome?

How much does decompressive laparotomy reduce the mortality rate in primary abdominal compartment syndrome?

A sudden presentation of abdominal compartment syndrome

High Abdominal Perfusion Pressure Using Umbilical Cord Flap in the Management of Gastroschisis

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