Decompressive Abdominal Laparotomy for Abdominal Compartment Syndrome in an Unengrafted Bone Marrow Recipient with Septic Shock

Abstract

Objective. To describe a profoundly immunocompromised (panleukopenia) child with septic shock who developed abdominal compartment syndrome (ACS) and was successfully treated with surgical decompression. Design. Individual case report. Setting. Pediatric intensive care unit of a tertiary children's hospital. Patient. A 32-month-old male with Fanconi anemia who underwent bone marrow transplantation (BMT) 5 days prior to developing septic shock secondary to Streptococcus viridans and Escherichia coli ACS developed after massive fluid resuscitation, leading to cardiopulmonary instability. Interventions. Emergent surgical bedside laparotomy and silo placement. Measurements and Main Results. The patient's cardiopulmonary status stabilized after decompressive laparotomy. The abdomen was closed and the patient survived to hospital discharge without cardiac, respiratory, or renal dysfunction. Conclusions. The use of laparotomy and silo placement in an unengrafted BMT patient with ACS and septic shock did not result in additional complications. Surgical intervention for ACS is a reasonable option for high risk, profoundly immunocompromised patients.

Decompressive laparotomy for abdominal compartment syndrome

“…Surgical decompression of the abdomen, or decompressive laparotomy (DL), is the only available definitive treatment for ACS. Numerous case reports and case series have been published detailing results, but the exact role of DL remains unclear. Most papers focus on the description of associated parameters such as airway pressure, central venous pressure or urinary output, rather than specifically looking at endpoints such as hospital mortality and organ function.…”

Acute Abdomen After Allogenic Haematopoietic Stem Cell Transplantation

“…Moreover, immuno-compromised children with ACPO, during the acute phase of disease, are not able to tolerate either surgery or the sequelae of procedures performed to solve the bowel distention, such as temporary ostomy or decompressive laparotomy with delayed closure. 1 – 4 In our patient, the ACPO arose during the aplastic phase after allo-HSCT as a consequence of neutropenic enterocolitis. This condition was also associated with dissemination of the adenovirus infection, the multiresistant K. Pneumoniae sepsis and the development of acute renal failure with uremic syndrome.…”

“…Abdominal complications in patients undergoing allo-HSCT could lead to catastrophic events, especially in the pediatric population. 1 Use of myeloablative therapies with subsequent immunodeficiency, together with underlying diseases and related treatments, may result in life-threatening situations which can prove fatal. In this respect, acute colonic pseudo obstruction (ACPO) represents a rare condition which has been reported in critical patients with prolonged hospitalization who develop neutropenic enterocolitis as a consequence of intensive therapies, such as antibiotics, chemotherapy and radiation.…”

The role of routine measurement of intra-abdominal pressure in preventing abdominal compartment syndrome

“…Surgical procedures such as percutaneous catheter decompression[ 21 22 ] and decompression laparostomy should be done as early as possible. [ 23 24 ]…”