Abdominal compartment syndrome in a three year old child following a severe burn injury

Abstract

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are recognized complications of burn resuscitation in adults. The incidence, management and outcome of ACS in the pediatric population are less clear. The patient is a 3-year-old male who suffered an 80% total body surface area (TBSA) burn and inhalation injury. He underwent three burn excisions and graftings in addition to standard critical care over the first week. On hospital day 13, he underwent a major burn excision and grafting of approximately 36% TBSA. Postoperatively, he developed hypotension, tachycardia, worsening anemia, and coagulopathy. A bladder pressure was found to be 37 mm Hg. He urgently underwent a decompressive laparotomy in the Pediatric Intensive Care Unit (PICU). Following decompression, his ventilatory status improved, and urine output returned to a normal rate. His abdomen was closed after six days. He went on to make a full recovery with no identifiable sequellae of ACS. Early recognition of abdominal compartment syndrome is crucial in all intensive care settings. Severely burned patients are at particular risk for the development of ACS due largely to the fluid requirement. Recognition of IAH and ACS should prompt changes in fluid management when possible. Decompressive laparotomy can be a live saving measure for patients with refractory ACS.