Peritoneal Drainage as a Safe Alternative to Laparotomy in Children with Abdominal Compartment Syndrome
Context: Abdominal compartment syndrome in children carries a mortality of 40–60%. Although definitive treatment for this condition traditionally involves decompressive laparotomy, percutaneous catheter drainage of associated ascites is described as an alternative to laparotomy in adults. Aims: We e...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2021-01-01
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| Series: | Pediatric Respirology and Critical Care Medicine |
| Subjects: | |
| Online Access: | https://journals.lww.com/10.4103/prcm.prcm_3_21 |
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| Summary: | Context:
Abdominal compartment syndrome in children carries a mortality of 40–60%. Although definitive treatment for this condition traditionally involves decompressive laparotomy, percutaneous catheter drainage of associated ascites is described as an alternative to laparotomy in adults.
Aims:
We explored the safety and efficacy of percutaneous catheter drainage of intraabdominal fluid for reversing abdominal compartment physiology in a critically-ill cohort of small children.
Materials and Methods:
We reviewed records of all children undergoing percutaneous catheter drainage for abdominal compartment syndrome from 2014 to 2018 in a single institution, excluding those who required drainage for other indications. Bedside sonogram-guided drainage using Seldinger technique or Penrose drain placement was performed by the pediatric surgical service, with drains removed on the resolution of compartment syndrome physiology and fluid output of <10 mL/day. Primary outcome measures were improvement in compartment physiology over 24 h.
Statistical Analysis:
Data were analyzed using descriptive statistics and paired Wilcoxon signed-rank tests. Statistical significance was assumed at P < 0.05.
Results:
Ten children ranging from 1.1 kg to 38 kg underwent 11 percutaneous catheter drainage procedures for abdominal compartment syndrome secondary to blood, serous fluid, air, or a combination. Significant physiologic improvement was seen across multiple variables including pulse rate, pH, and lactate. No patients later required decompressive laparotomy. Four patients died due to their primary disease.
Conclusion:
Percutaneous catheter drainage is safe and efficacious in reversing abdominal compartment physiology in children with intraabdominal fluid, and can be considered prior to surgical intervention when clinically appropriate. |
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| ISSN: | 2543-0343 2543-0351 |