A Case of Open Abdominal Management and CHDF for Abdominal Compartment Syndrome After Bowel Perforation

Abstract

The patient was a boy, 19 days old. He came to the hospital with the chief complaint of vomiting and bloody stools, and the diagnosis was left inguinal hernia. An abdominal ultrasonography showed good intestinal blood flow, and the patient was manually repositioned. Contrast-enhanced CT of the abdomen showed intestinal dilatation and ascites, and gastrointestinal perforation was suspected, so an emergency laparotomy and partial resection of the small intestine were performed. However, postoperatively, abdominal compartment syndrome was observed, and a stoma was created to decompress the abdomen. However, because intra-abdominal decompression was insufficient and anuria persisted, a silo was created, and the patient was placed on continuous hemodiafiltration (CHDF) to remove inflammatory mediators. The patient was able to wean from CHDF in 9 days. He was discharged from the PICU on day 44 of hospitalization and discharged on day 97 of hospitalization.

The management of abdominal compartment syndrome was difficult, but silo placement and CHDF were effective, and we report this case.