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. 2015 Winter;23(4):218-20.
doi: 10.4172/plastic-surgery.1000939.

Ischemic bowel as a late sequela of abdominal compartment syndrome secondary to severe burn injury

Ken Sun  1 , Betty Jean Hancock  2 , Sarvesh Logsetty  3
Affiliations

Ischemic bowel as a late sequela of abdominal compartment syndrome secondary to severe burn injury

Ken Sun et al. Plast Surg (Oakv). 2015 Winter.

Abstract
in English, French

Abdominal compartment syndrome (ACS) is a known complication of the large-volume resuscitation that burn patients receive. Bowel ischemia has been theorized to occur in ACS but has yet to be described in the literature. The authors report an occurrence of late bowel obstruction related to ACS-associated bowel ischemia in a burn patient. A four-year-old previously well girl sustained 70% total body surface area burns with inhalation injury. The areas injured were the anterior neck, circumferential torso from neck to waist, left arm, left thigh and two-thirds of her right thigh. Fluid resuscitation was initially administered using the modified Parkland formula. Her transfer to the regional burn unit from a local hospital was complicated by early septic shock from a line infection, which increased her resuscitation fluid requirements. Infection ultimately led to multiple instances of ACS. Intervention with percutaneous drainage led to immediate improvement; however, the episodes of ACS resulted in a late small bowel obstruction secondary to stricture, requiring a laparotomy and bowel resection.

Le syndrome du compartiment abdominal (SCA) est une complication connue du volume liquidien important que reçoivent les patients brûlés pendant la réanimation. Théoriquement, l’ischémie intestinale est liée au SCA, mais elle n’a jamais été décrite dans des publications scientifiques. Les auteurs présentent un cas d’obstruction intestinale tardive liée à une ischémie intestinale associée à un SCA chez une patiente brûlée.Une fillette de quatre ans auparavant en santé a subi des brûlures sur 70 % de la surface totale de son corps, de même que des brûlures par inhalation. Elle était brûlée sur la partie antérieure du cou, la circonférence du torse entre le cou et la taille, le bras gauche, la cuisse gauche et les deux tiers de la cuisse droite. La réanimation liquidienne a d’abord été administrée selon la formule de Parkland modifiée. Le transfert de la patiente d’un hôpital local à l’unité régionale des brûlés a été compliqué par un choc septique précoce causé par une infection liée à un cathéter, ce qui a accru la réanimation liquidienne. L’infection a provoqué de multiples SCA. Un drain percutané a favorisé une amélioration clinique immédiate de la patiente, mais les épisodes de SCA ont entraîné une obstruction tardive de l’intestin grêle attribuable à un rétrécissement, laquelle a exigé une laparotomie et une résection intestinale.

Keywords: Abdominal compartment syndrome; Burns; Ischemic bowel; Pediatrics.

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Figures

Figure 1)
Figure 1)
The incidence of abdominal compartment syndrome (ACS) was tracked on this day by a steadily declining urine output (U/O). Because of clinical signs of distension, loss of bowel sounds and a measured bladder pressure of 20 mmHg (27 cmH2O), a percutaneous drain was inserted just after 21:00, and 800 mL of clear amber fluid was collected from the drain. Subsequent parameters showed significant improvement in abdominal perfusion, suggesting that the ACS has been resolved and organ function (U/O) has returned to normal. APP Abdominal perfusion pressure; IAP Intra-abdominal pressure; MAP Mean arterial pressure
Figure 2)
Figure 2)
Signs of proximal dilation
Figure 3)
Figure 3)
Thickening and hypertrophy of the small bowel
See this image and copyright information in PMC

References

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