First Report of Fatal Secondary Abdominal Compartment Syndrome Induced by Intestinal Gas Accumulation without Organic Occlusive Intestinal Lesion in a Child with Sepsis

Abstract

BACKGROUND Abdominal compartment syndrome (ACS), characterized by an increased intra-abdominal pressure and new-onset organ dysfunction, is a critical and potentially fatal condition, with no case of ACS caused by intestinal gas without intestinal lesion being reported to date. CASE REPORT A 2-year-old girl with a chromosomal abnormality of 1p36 deletion presented with fever and diarrhea following upper-gastrointestinal series for the evaluation of gastroesophageal reflux. After 20 days, she experienced septic shock and multiple-organ failure, accompanied with rapidly growing, severe abdominal distension. A marked increase in the intra-abdominal pressure was indicated by the complete loss of elasticity in the extremely hard and distended abdomen. She died 14 h after the onset of shock. Her autopsy examination revealed extensive pneumonia and excessive intestinal gas, despite no occlusive intestinal lesion present. CONCLUSIONS It is critical to be aware that secondary ACS can occur following sepsis due to the accumulation of extensive intestinal gas, without an occlusive intestinal lesion.

Figure 1.

Progression of abdominal distention caused by the accumulation of intestinal gas on X-ray. (A) At 5 days before shock (anteroposterior only). There is relatively less intestinal gas. (B) Just before shock (anteroposterior only). There is a significant increase in the amount of intestinal gas. (C) Three hours after shock (anteroposterior only). The amount of intestinal gas is further increased. (D) Seven hours after shock (lateral only). The abdominal distention has progressed and the abdomen has become much stiffer.

Figure 2.

Autopsy findigs. (A) On the body surface, skin reddening is observed on the lower extremities and lower abdomen. (B) A large amount of the intestinal gas is accumulated. (C) The intestinal mucosa is macroscopically unremarkable. (D) Histological studies showing congestion but not intestinal edema or inflammation. Note that the autopsy was performed 23.5 h after death, during which the body was maintained in a cooler. Hence, the abdominal dilation at autopsy was decompressed by cooling in comparison with that before death.