Decompressive abdominal laparotomy for abdominal compartment syndrome in an unengrafted bone marrow recipient with septic shock.

Derrick J N Dauplaise,Sean J Barnett,Jason S Frischer,Hector R Wong

doi:10.1155/2010/102910

Derrick J N Dauplaise, Sean J Barnett + Show 2 more

Open Access

https://doi.org/10.1155/2010/102910

Copy DOI

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.

Highlights

ObjectiveTo describe a profoundly immunocompromised (panleukopenia) child with septic shock who developed abdominal compartment syndrome (ACS) and was successfully treated with surgical decompression
Intra-abdominal hypertension (IAH) leading to abdominal compartment syndrome (ACS) is increasingly being recognized as a cause of morbidity and organ dysfunction, which includes respiratory insufficiency, compromised renal perfusion, and decreased cardiac output from impaired venous return, but can included any organ dysfunction caused by IAH
From review of the literature and to our knowledge this is the first case report of decompressive laparotomy for abdominal compartment syndrome for a bone marrow transplantation (BMT) patient with septic shock. This patient had several chronic issues related to his Fanconi anemia; his state of health was different from many BMT patients frequently encountered with sepsis in the ICU

Summary

Objective

To describe a profoundly immunocompromised (panleukopenia) child with septic shock who developed abdominal compartment syndrome (ACS) and was successfully treated with surgical decompression. 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. Emergent surgical bedside laparotomy and silo placement. 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. 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

Introduction

Findings

Discussion

Summary