Severe constipation in a pediatric patient causing abdominal compartment syndrome

Abstract

Abstract Introduction Abdominal compartment syndrome is defined as elevated intra-abdominal pressure, and typically presents following trauma or burns in adults or in neonates with abdominal wall defects1. A definitive cutoff value for intra-abdominal pressure is unknown in pediatric patients. Case presentation 8 year old male with no previous past medical history presented with abdominal compartment syndrome due to constipation and distention of 2 weeks duration, despite multiple laxatives and enemas. The patient was treated with rectal decompression followed by decompressive laparotomy and delayed abdominal closure with end ileostomy creation. Discussion Reperfusion syndrome is a complex inflammatory response and may cause further injury to the tissues. This occurs partially due to microvascular dysfunction, increased permeability of capillaries and arterioles, and release of transcription factors leading to prolonged ileus and further intestinal distention. Reperfusion can cause a secondary/recurrent compartment syndrome, and in order to prevent and control sequela of reperfusion, decompressive laparotomy should be performed with temporary abdominal closure, regardless of the cause of abdominal compartment syndrome. Conclusion Constipation is a rare cause of ACS; regardless of cause of ACS, treatment should be decompressive laparotomy with temporary abdominal closure, and continued resuscitation as appropriate. A higher index of suspicion is needed in pediatric patients without obvious cause for ABS given that the abdominal exam is not always reliable, and due to the potential for life-threatening complications in the event of a missed diagnosis.