Abdominal compartment syndrome in children: CT findings

Abstract

Abdominal compartment syndrome (ACS) is caused by pathological elevation of intra-abdominal pressure (IAP) leading to multiple organ dysfunction syndrome. Since the condition is highly lethal, early diagnosis is imperative. We evaluated the pre-operative abdominal CT scans of three children with proven ACS to identify signs of elevated IAP. Findings common to these patients included narrowing of the inferior vena cava (IVC), direct renal compression or displacement, bowel wall thickening with enhancement and a rounded appearance of the abdomen. The aim of recognising the CT findings in such cases is to plan emergency surgical decompression. Although these findings are not specific for increased IAP, radiologists should be aware of this life-threatening condition and, in the proper clinical setting, should communicate the presence and significance of these findings to the referring clinician.

Intra-abdominal hypertension and the abdominal compartment syndrome

“…Peak airway pressure and 24-h fluid balance are two independent variables that can be used to predict the development of ACS in non-trauma surgical patients 51 . Computed tomographic changes have also been reported, such as narrowing of the IVC, direct renal compression and bowel wall thickening with a rounded abdomen 55 . Methods for diagnosing ACS at an earlier stage are being developed; these are based on early evidence of splanchnic hypoperfusion and acidosis.…”

Modern imaging techniques in intra-abdominal hypertension and abdominal compartment syndrome: a bench to bedside overview

“…Only a few small studies have identified characteristic CT imaging features of IAH and ACS [4][5][6][7][8]. Key to ACS management is acknowledging that IAH is secondary to underlying pathology, frequently systemic inflammatory response syndrome (SIRS), bleeding, or fluid extravasation [9].…”

Secondary abdominal compartment syndrome in a case of pediatric trauma shock resuscitation

“…Although ACS is typically identified clinically (14), intravesicular pressure monitoring (15) and CT abdominal imaging (8 -11) aid in ACS diagnosis. CT analyses of ACS in adult (8) and pediatric (10,11) patients show free peritoneal fluid, inferior vena cava compression, and bowel wall thickening and enhancement. The "round belly sign" on CT is diagnostic of ACS in adult patients (100% sensitivity, 94% specificity) as an anteroposterior-to-transverse abdominal ratio Ͼ0.80, measured at the level of the left renal vein (8).…”