| ORIGINAL ARTICLE |
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| Year : 2021 | Volume
: 5
| Issue : 1 | Page : 2-5 |
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Peritoneal drainage as a safe alternative to laparotomy in children with abdominal compartment syndrome
Beatrix Hyemin Choi, Rivfka Shenoy, Dina Levy-Lambert, Jason C Fisher, Sandra S Tomita
Department of Surgery, Division of Pediatric Surgery, NYU School of Medicine, Hassenfeld Children’s Hospital at NYU Langone, New York, NY, USA
Correspondence Address:
Dina Levy-Lambert
530 First Ave., Suite 10W, New York, NY 10016.
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/prcm.prcm_3_21
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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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