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An increased intra-abdominal pressure can result in a manifest abdominal compartment syndrome (ACS) with significant organ damage, which is a life-threatening situation associated with a high mortality. Although the etiology is manifold and critically ill patients on the intensive care unit are particularly endangered, the disease is often not diagnosed even though the measurement of bladder pressure is available as a simple and standardized method; however, particularly the early detection of an increased intra-abdominal pressure is decisive in order to prevent the occurrence of a manifest ACS with (multi)organ failure by means of conservative measures. In cases of a conservative refractory situation, decompressive laparotomy is indicated. [ABSTRACT FROM AUTHOR]

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Abdominal compartment syndrome (ACS) is a rare complication of extracorporeal membrane oxygenation (ECMO) and is associated with high morbidity and mortality. Despite being the treatment of choice for ACS, decompressive laparotomy (DL) has been a matter of debate in children supported with ECMO due to high bleeding risk and presumed futility. We report the first neonatal DL for ACS while on ECMO following congenital diaphragmatic hernia (CDH) repair. Given its excellent outcomes, our case challenges current literature and supports prompt bedside laparotomy to treat ACS on neonatal ECMO. [ABSTRACT FROM AUTHOR]

Introduction: Although extrapulmonary complications can occur in cases of severe Respiratory Syncytial Virus (RSV) infections, abdominal compartment syndrome (ACS) has not previously been described in the context of RSV. In this case series we describe two infants who presented with severe RSV and subsequently developed ACS. Case presentations: Case 1: A 7-week-old term infant with severe RSV requiring intubation and care in the ICU. Shortly after admission, she became septic with abdominal distention and erythema, concerning for an intra-abdominal source. In addition, she had increased peak airway and bladder pressures suggestive of ACS. An abdominal ultrasound revealed significant ascites and dilated loops of bowel, but no suitable window for drainage. Given the possibility of intra-abdominal sepsis and ACS, an exploratory and decompressive laparotomy was performed revealing colitis and tense ascites. After relief of ACS, she quickly recovered with successful closure of her abdomen and eventual resolution of her ascites.Case 2: A 6-month-old preterm infant who presented similarly to Case 1 with symptoms of severe RSV. A few days after ICU admission, she developed abdominal distention with hemodynamic instability, acute kidney injury, and rising bladder pressures, suggestive of ACS. She then urgently underwent a decompressive laparotomy with similar findings of tense ascites and colitis. Despite surgical decompression, however, her sepsis worsened post-operatively with evidence of multisystem organ failure, including hemodynamic instability, anasarca, and coagulopathy. Ultimately, she succumbed to her illness. Conclusion: Our case series shows that infants with severe RSV are at risk for ACS, which can be deadly despite surgical intervention.

The use of extracorporeal membrane oxygenation (ECMO) has increased over the course of the SARS-CoV-2 pandemic. Intra-abdominal hypertension resulting in abdominal compartment syndrome (ACS) during ECMO support is a rare but life-threatening complication, with previous case series describing mortality rates of 44%-100%. Bleeding complications, linked to both patient-related and device-related factors, also characterize prolonged ECMO support and have been reported in up to 60% of ECMOpatients. We hereby describe a critically ill COVID-19 patient who underwent emergent bed-side decompressive laparotomy for acute ECMO failure related to the development of ACS. The discussion is focused on surgical considerations including the delicate balance between anticoagulation and thrombosis, as anticoagulation-free ECMO support may be required due to hemorrhagic complications. [ABSTRACT FROM AUTHOR]

Introduction: Decompressive craniectomy (DC) is the ultimate intervention to lower intracranial pressure (ICP) following severe traumatic brain injury (TBI). However, this intervention is associated with considerable adverse events and a higher proportion of survivors with poor functional outcomes. Research question: In a multicompartment system ICP is associated with intraabdominal pressure (IAP) due to cerebral venous outflow from the brain. This is the rationale for decompressive laparotomy (DL) to control ICP after TBI as reported by experimental and retrospective clinical data. The safety profile of DL is superior to DC. This study aims to randomly assign patients with intractable high ICP after severe TBI to DL or DC. Material and methods: Among other inclusion criteria, ICP must be above 20 mmHg (1–12 h) despite sedation and all other measures according to current guidelines. The primary outcome is the Extended Glasgow Outcome Scale assessed after twelve months. Further secondary outcome measures are compartmental pressure values, complications, etc. After 20 initial patients, results will be reviewed by the ethics committees and safety monitoring board to decide on the enrolment of 80 additional patients. Results: The study is designed to provide not only high-quality prospective data for the first time on this treatment approach, its two-stage design (20 + 80 pts) also provides maximum patient safety. This protocol conforms with the SPIRIT 2013 Statement. Ethics approval was granted by our but also 5 other university ethics committees (registration 473/18S). Conclusion: Registration was performed prior to study initiation in November 2021 (registration number NCT 05115929).

• Laparotomy and/or open abdomen during ECMO may elevate risk of bleeding and infection. The literature is inconclusive regarding whether risks outweigh benefits. • Decompressive laparotomy and open abdomen in children on ECMO correlated with lower complications and no difference in mortality or bleeding compared to ECMO without open abdomen. Decompressive laparotomy and open abdomen for abdominal compartment syndrome have been historically avoided during Extracorporeal Membrane Oxygenation (ECMO) due to seemingly elevated risks of bleeding and infection. Our goal was to evaluate a cohort of pediatric respiratory ECMO patients who underwent decompressive laparotomy with open abdomen at a single institution and to compare these patients to ECMO patients without open abdomen. We reviewed all pediatric respiratory ECMO (30 days-18 years) patients treated with decompressive laparotomy with open abdomen at Riley Hospital for Children (1/2000–12/2019) and compared these patients to concurrent respiratory ECMO patients with closed abdomen. We excluded patients with surgical cardiac disease. We assessed demographics, ECMO data, and outcomes and defined significance as p = 0.05. 6 of 81 ECMO patients were treated with decompressive laparotomy and open abdomen. Open and closed abdomen groups had similar age (p = 0.223) and weight (0.286) at cannulation, but the open abdomen group had a higher reliance on vasoactive medications (Vasoactive Inotropic Score, p = 0.040). Open abdomen group survival was similar to closed abdomen patients (66.7%, vs 62.7%, p = 1). Open abdomen patients had lower incidence of ECMO complications (33.3% vs 83.6%, p = 0.014), but the groups had similar bleeding complications (p = 0.412) and PRBC transfusion volume (p = 0.941). Pediatric ECMO patients with open abdomen after decompressive laparotomy had similar survival, blood products administered, and complications as those with a closed abdomen. An open abdomen is not a contra-indication to ECMO support in pediatric respiratory patients and should be considered in select patients. [ABSTRACT FROM AUTHOR]

Abdominal compartment syndrome (ACS) is a devastating condition for the critically unwell patient. Initially described as solely affecting surgical patients, ACS is now also recognized in the medical intensive care setting. Without prompt and definitive treatment mortality rates approach 70% as multi-organ failure develops. Over the past decade our understanding, recognition and management of ACS has evolved. The World Society of Abdominal Compartment Syndrome published updated guidelines in 2012 to draw consensus and improve patient outcomes. ACS is the end sequela of raised intra-abdominal pressure (IAP), defined as a sustained IAP >20 mmHg with or without an abdominal perfusion pressure <60 mmHg and associated with new organ dysfunction. Intravesical measuring of IAP is the gold standard diagnostic technique. Surgical decompressive laparotomy and open abdomen with temporary abdominal closure measures is the definitive treatment. This article summarizes the updated consensus definitions, pathophysiology, diagnostic investigation and management to help the junior surgical trainee faced with ACS. [ABSTRACT FROM AUTHOR]

INTRODUCTION Abdominal compartment syndrome (ACS), defined as intra-abdominal pressure (IAP) greater than 20 mm Hg that is associated with new organ dysfunction/failure, represents na uncommon but hazardous complication after endovascular aneurysm repair for ruptured abdominal aortic aneurysms (r-EVAR). The aim of this review is to overview incidence, mortality and potential benefit of expedite treatment of ACS. METHODS Pubmed databases were searched in order to find publications reporting incidence associated mortality of ACS after r-EVAR. Articles published before 2002 and non-human data was not included. RESULTS Among larger studies (n>100) ACS incidence ranged between 6.9 to 20%, with significant heterogeneity among included studies. Significant heterogeneity was also find regarding in-hospital mortality, ranging between 30 to 83%. One study revealed that need for decompressive laparotomy carried a significan greater risk of in-hospital mortality (odds ratio [OR], 5.91; 95% confidence interval [CI], 3.62-9.62;P 12mmHg. When the latter reveal innefective, decompressive laparotomy is mandatory to avoid multi-organ failure. No studies comparing effectiveness of decompressive laparotomy exist in the literature as this represents a rescuing measure.

Although extrapulmonary complications can occur in cases of severe Respiratory Syncytial Virus (RSV) infections, abdominal compartment syndrome (ACS) has not previously been described in the context of RSV. In this case series we describe two infants who presented with severe RSV and subsequently developed ACS. Case 1: A 7-week-old term infant with severe RSV requiring intubation and care in the ICU. Shortly after admission, she became septic with abdominal distention and erythema, concerning for an intra-abdominal source. In addition, she had increased peak airway and bladder pressures suggestive of ACS. An abdominal ultrasound revealed significant ascites and dilated loops of bowel, but no suitable window for drainage. Given the possibility of intra-abdominal sepsis and ACS, an exploratory and decompressive laparotomy was performed revealing colitis and tense ascites. After relief of ACS, she quickly recovered with successful closure of her abdomen and eventual resolution of her ascites. Case 2: A 6-month-old preterm infant who presented similarly to Case 1 with symptoms of severe RSV. A few days after ICU admission, she developed abdominal distention with hemodynamic instability, acute kidney injury, and rising bladder pressures, suggestive of ACS. She then urgently underwent a decompressive laparotomy with similar findings of tense ascites and colitis. Despite surgical decompression, however, her sepsis worsened post-operatively with evidence of multisystem organ failure, including hemodynamic instability, anasarca, and coagulopathy. Ultimately, she succumbed to her illness. Our case series shows that infants with severe RSV are at risk for ACS, which can be deadly despite surgical intervention. [ABSTRACT FROM AUTHOR]

Abstract Background Intra-abdominal hypertension is frequently present in critically ill patients and is an independent predictor for mortality. Risk factors for intra-abdominal hypertension and abdominal compartment syndrome have been widely investigated. However, data are lacking on prevalence and outcome in high-risk patients. Our objectives in this study were to investigate prevalence and outcome of intra-abdominal hypertension and abdominal compartment syndrome in high-risk patients in a prospective, observational, single-center cohort study. Results Between March 2014 and March 2016, we included 503 patients, 307 males (61%) and 196 females (39%). Patients admitted to the intensive care unit with a diagnosis of pancreatitis, elective or emergency open abdominal aorta surgery, orthotopic liver transplantation, other elective or emergency major abdominal surgery and trauma were enrolled. One hundred and sixty four (33%) patients developed intra-abdominal hypertension and 18 (3.6%) patients developed abdominal compartment syndrome. Highest prevalence of abdominal compartment syndrome occurred in pancreatitis (57%) followed by orthotopic liver transplantation (7%) and abdominal aorta surgery (5%). Length of intensive care stay increased by a factor 4 in patients with intra-abdominal hypertension and a factor 9 in abdominal compartment syndrome, compared to patients with normal intra-abdominal pressure. Rate of renal replacement therapy was higher in abdominal compartment syndrome (38.9%) and intra-abdominal hypertension (8.2%) compared to patients with normal intra-abdominal pressure (1.2%). Both intensive care mortality and 90-day mortality were significantly higher in intra-abdominal hypertension (4.8% and 15.2%) and abdominal compartment syndrome (16.7% and 38.9%) compared to normal intra-abdominal pressure (1.2% and 7.1%). Body mass index (odds ratio 1.08, 95% confidence interval 1.03–1.13), mechanical ventilation at admission (OR 3.52, 95% CI 2.08–5.96) and Apache IV score (OR 1.03, 95% CI 1.02–1.04) were independent risk factors for the development of intra-abdominal hypertension or abdominal compartment syndrome. Conclusions The prevalence of abdominal compartment syndrome was 3.6% and the prevalence of intra-abdominal hypertension was 33% in this cohort of high-risk patients. Morbidity and mortality increased when intra-abdominal hypertension or abdominal compartment syndrome was present. The patient most at risk of IAH or ACS in this high-risk cohort has a BMI > 30 kg/m2 and was admitted to the ICU after emergency abdominal surgery or with a diagnosis of pancreatitis.

Martin Padar,1,2 Annika Reintam Blaser,2,3 Peep Talving,4,5 Edgar Lipping,6 Joel Starkopf1,2 1Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia; 2Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia; 3Department of Intensive Care, Lucerne Cantonal Hospital, Lucerne, Switzerland; 4Department of Surgery, University of Tartu, Tartu, Estonia; 5Management Board, North Estonia Medical Centre, Tallinn, Estonia; 6Department of Surgery, Division of Acute Care Surgery, North Estonia Medical Centre, Tallinn, EstoniaCorrespondence: Annika Reintam BlaserDepartment Of Intensive Care, Lucerne Cantonal Hospital, Spitalstrasse, Lucerne 6000, SwitzerlandTel +41 79 514 21 21Email Annika.Reintam.Blaser@ut.eeAbstract: Abdominal compartment syndrome (ACS) refers to a severe increase in intra-abdominal pressure associated with single or multiorgan failure. ACS with specific pathophysiological processes and detrimental outcomes may occur in a variety of clinical conditions. Patients with ACS are predominantly managed in critical care settings, however, a wide range of multidisciplinary interventions are frequently required from medical, surgical, radiological and nursing specialties. The medical management, aiming to prevent the progression of intra-abdominal hypertension to ACS, is extensively reviewed. Timing and techniques of surgical decompression techniques, as well as management of open abdomen, are outlined. In summary, the current narrative review provides data on history, definitions, epidemiology and pathophysiology of the syndrome and highlights the importance of multidisciplinary approach in the management of ACS in adults.Keywords: intra-abdominal hypertension, abdominal compartment syndrome, abdominal decompression, decompressive laparotomy, damage control surgery, open abdomen

Introduction: Abdominal compartment syndrome is defined as elevated intra-abdominal pressure, and typically presents following trauma or burns in adults or in neonates with abdominal wall defects1. A definitive cutoff value for intra-abdominal pressure is unknown in pediatric patients. Case presentation: 8 year old male with no previous past medical history presented with abdominal compartment syndrome due to constipation and distention of 2 weeks duration, despite multiple laxatives and enemas. The patient was treated with rectal decompression followed by decompressive laparotomy and delayed abdominal closure with end ileostomy creation. Discussion: Reperfusion syndrome is a complex inflammatory response and may cause further injury to the tissues. This occurs partially due to microvascular dysfunction, increased permeability of capillaries and arterioles, and release of transcription factors leading to prolonged ileus and further intestinal distention. Reperfusion can cause a secondary/recurrent compartment syndrome, and in order to prevent and control sequela of reperfusion, decompressive laparotomy should be performed with temporary abdominal closure, regardless of the cause of abdominal compartment syndrome. Conclusion: Constipation is a rare cause of ACS; regardless of cause of ACS, treatment should be decompressive laparotomy with temporary abdominal closure, and continued resuscitation as appropriate. A higher index of suspicion is needed in pediatric patients without obvious cause for ABS given that the abdominal exam is not always reliable, and due to the potential for life-threatening complications in the event of a missed diagnosis.

Abstract Background Abdominal compartment syndrome (ACS) is associated with mortality in patients with critical illness such as severe acute pancreatitis, but it remains unclear whether decompressive laparotomy for ACS can improve the prognosis of patients. Case presentation A woman in her 60s visited our hospital because of upper abdominal pain. On the basis of her laboratory data and abdominal contrast-enhanced computed tomography findings, acute gallstone pancreatitis was diagnosed. She underwent endoscopic sphincterotomy for the removal of the common bile duct stone. Then, a drainage tube was placed in the bile duct. However, on the 5th hospital day, her intra-abdominal pressure increased to 22 mmHg and renal dysfunction was observed, which led to the diagnosis of ACS. As intensive medical treatments did not improve her ACS, she underwent decompressive laparotomy on the 9th hospital day. Postoperatively, her laboratory data and intravesical pressure improved, and she was discharged from the hospital after abdominal closure, continuous drainage, and antibiotic therapy. Conclusion As the effectiveness of decompressive laparotomy for ACS has not been established, this treatment indication remains controversial. Decompressive laparotomy is considered useful for the management of ACS, if it is performed at an appropriate time, as in the present case.

We suggest that during severe acute pancreatitis (SAP) with intra-abdominal hypertension, practitioners should consider decompressive laparotomy, even with intra-abdominal pressure (IAP) below 25 mmHg. Indeed, in this setting, non-occlusive mesenteric ischemia (NOMI) may occur even with IAP below this cutoff and lead to transmural necrosis if abdominal perfusion pressure is not promptly restored. We report our experience of 18 critically ill patients with SAP having undergone decompressive laparotomy of which one third had NOMI while IAP was mostly below 25 mmHg., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Abdominal Compartment Syndrome (ACS), despite recent advances in medical and surgical care, is a significant cause of mortality. The purpose of this review is to present the main diagnostic and therapeutic aspects from the anesthetical and surgical points of view. Intra-abdominal hypertension may be diagnosed by measuring intra-abdominal pressure and indirectly by imaging and radiological means. Early detection of ACS is a key element in the ACS therapy. Without treatment, more than 90% of cases lead to death and according with the last reports, despite all treatment measures, the mortality rate is reported as being between 25 and 75%. There are conflicting reports as to the importance of a conservative therapy approach, although such an approach is the central to treatment guidelines of the World Society of Abdominal Compartment Syndrome, Decompressive laparotomy, although a backup solution in ACS therapy, reduces mortality by 16-37%. The open abdomen management has several variants, but negative pressure wound therapy represents the gold standard of surgical treatment.

Abstract Background Decompressive laparotomy has been advised as potential treatment for abdominal compartment syndrome (ACS) when medical management fails; yet, the effect on parameters of organ function differs markedly in the published literature. In this study, we sought to investigate the effect of decompressive laparotomy on intra-abdominal pressure and organ function in critically ill adult and pediatric patients with ACS, specifically focusing on hemodynamic, respiratory, and kidney function and outcome. Methods A systematic review and meta-analysis of the literature was performed. Articles reporting data on intra-abdominal pressure (IAP), hemodynamic (mean arterial pressures [MAP], central venous pressure [CVP], cardiac index [CI], heart rate [HR], systemic vascular resistance index [SVRI] and/or pulmonary capillary wedge pressure [PCWP]), respiratory (positive end-expiratory pressure [PEEP], peak inspiratory pressure [PIP] and/or ratio of partial pressure arterial oxygen and fraction of inspired oxygen [P/F ratio]), and/or urinary output (UO) following decompressive laparotomy were analyzed. Results A total of 15 articles were included; 3 included children only (aged 18 years or younger). Of the 286 patients who were included, 49.7% had primary ACS. The baseline mean IAP in adults decreased with an average of 18.2 ± 6.5 mmHg following decompression, from 31.7 ± 6.4 mmHg to 13.5 ± 3.0 mmHg. There was a decrease in HR (12.2 ± 9.5 beats/min; p = 0.04), CVP (4.6 ± 2.3 mmHg; p = 0.022), PCWP (5.8 ± 2.3 mmHg; p = 0.029), and PIP (10.1 ± 3.9 cmH2O; p

Purpose: Abdominal compartment syndrome (ACS) in children results in 100% mortality if left untreated. Decompressive laparotomy (DL) is the only effective treatment if conservative medical therapies have failed. This study aims to determine the incidence of ACS among pediatric patients who underwent an emergency laparotomy (EL), to describe the effect of DL on clinical and laboratory parameters and, to make a better prediction on fatal outcome, to analyze variables and their association with mortality.Methods: This retrospective study includes 418 children up to the age of 16 years who underwent EL between January 2010 and December 2018 at our tertiary pediatric referral center. ACS was defined according to the latest guidelines of the World Society of the Abdominal Compartment Syndrome.Results: Fourteen patients had emergency DL for ACS. 6 h preoperatively; median intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) were 22.5 mmHg and 29 mmHg, respectively. After DL, IAP decreased and APP increased, both by an average of 60%. Six patients survived, eight patients had a fatal outcome, resulting in a mortality of 57%. An age under 1 year, weight under the 3rd percentile, an open abdomen treatment, an intestinal resection and an elevated serum lactate > 1.8 mmol/L were associated with an increased relative risk of death.Conclusions: Improving the outcome in pediatric patients with ACS by removing or attenuating risk factors is difficult. This emphasizes the need for early diagnosis and prompt DL once the diagnosis of ACS is made. [ABSTRACT FROM AUTHOR]

The article presents an analysis of modern methods of the measurement, including classical and original methods and devices developed by the authors. The results of examination and treatment were analyzed in 397 patients with acute obturation intestinal obstruction and acute destructive pancreatitis, who had the abdominal compartment syndrome from I to IV degree. The authors showed that on-time decompressive laparotomy allowed the decrease of lethality from 25% to 15-17,8%.

Abdominal compartment syndrome (ACS) is a devastating condition for the critically unwell patient. Initially described as solely affecting surgical patients, ACS is now also recognized in the medical intensive care setting. Without prompt and definitive treatment, mortality rates approach 70% as multiorgan failure develops. Over the past decade our understanding, recognition and management of ACS has evolved. The World Society of Abdominal Compartment Syndrome published updated guidelines in 2012 to draw consensus and improve patient outcomes. ACS is the end sequala of raised intra-abdominal pressure (IAP), defined as a sustained IAP >20 mmHg with or without an abdominal perfusion pressure <60 mmHg and associated with new organ dysfunction. Intravesical measuring of IAP is the gold standard diagnostic technique. Surgical decompressive laparotomy and open abdomen with temporary abdominal closure measures is the definitive treatment. This article summaries the updated consensus definitions, pathophysiology, diagnostic investigation and management to help the junior surgical trainee faced with ACS. [ABSTRACT FROM AUTHOR]

Background: Limited data exist regarding intraabdominal hypertension/abdominal compartment syndrome (IAH/ACS) after pelvic fractures. We aimed to explore risk factors for IAH/ACS in pelvic fracture patients, assess the physiological effects of decompressive laparotomy (DL) on IAH/ACS, and generate an algorithm to manage IAH/ACS after pelvic fracture.Materials and Methods: Pelvic fracture patients were included based on the presence of IAH/ACS. Intraabdominal pressure (IAP) was measured through a Foley catheter. DL was performed in patients with refractory IAH or ACS. Multivariable linear regression was applied to assess associations between IAP levels (≥12 mmHg) and age, sex, injury severity score (ISS), pelvic fracture, volume of resuscitation fluids over 24 h and hemoglobin values. The Wilcoxon signed-rank test for paired samples was used to compare variables before and after DL.Results: Among 455 pelvic fracture patients, 44 (9.7%) and 5 (1.1%) were diagnosed with IAH and ACS, respectively. The volume of resuscitation fluids over 24 h exhibited a significant positive correlation with IAP levels (≥12 mmHg) (p = 0.002). The main findings during DL were edematous bowel (11/20) and retroperitoneal hematoma (7/20). DL caused a significant decrease in the mean IAP from 24.4 ± 8.5 mmHg to 13.4 ± 4.0 mmHg (p < 0.0001). Physiological parameters (APP, PaO2/FIO2 ratio, PIP, arterial lactate and UOP) were significantly improved after DL. The mortality rate was 15% in patients who underwent DL and 40% in ACS patients.Conclusions: IAH/ACS is common in pelvic fracture patients. The most effective method to decrease IAP in pelvic fracture patients is DL. Prophylactic DL is important for decreasing mortality as it prevents IAH from progressing to ACS. Massive fluid resuscitation is a significant risk factor for IAH/ACS. A pathway incorporating prophylactic/therapeutic DL and optimized fluid resuscitation to prevent and manage IAH/ACS after pelvic fractures may reduce morbidity and mortality. [ABSTRACT FROM AUTHOR]

Norovirus infection is a leading cause of infectious gastroenteritis and is typically self-limited. Abdominal compartment syndrome is rare in the pediatric population. To date, there have been no reports of abdominal compartment syndrome secondary to Norovirus infection. This patient is a 7-year old female who presented with abdominal compartment syndrome and fulminant sepsis attributed to acute Norovirus infection. The patient was successfully treated with decompressive laparotomy, delayed abdominal closure, and supportive therapy. The patient's post-operative course was notable for acute hepatitis and pancreatitis, which resolved without further intervention. The patient was discharged home after a prolonged hospital stay in good condition.

Introduction: Decompressive craniectomy (DC) is the ultimate intervention to lower intracranial pressure (ICP) following severe traumatic brain injury (TBI). However, this intervention is associated with considerable adverse events and a higher proportion of survivors with poor functional outcomes., Research Question: In a multicompartment system ICP is associated with intraabdominal pressure (IAP) due to cerebral venous outflow from the brain. This is the rationale for decompressive laparotomy (DL) to control ICP after TBI as reported by experimental and retrospective clinical data. The safety profile of DL is superior to DC. This study aims to randomly assign patients with intractable high ICP after severe TBI to DL or DC., Material and Methods: Among other inclusion criteria, ICP must be above 20 mmHg (1-12 h) despite sedation and all other measures according to current guidelines. The primary outcome is the Extended Glasgow Outcome Scale assessed after twelve months. Further secondary outcome measures are compartmental pressure values, complications, etc. After 20 initial patients, results will be reviewed by the ethics committees and safety monitoring board to decide on the enrolment of 80 additional patients., Results: The study is designed to provide not only high-quality prospective data for the first time on this treatment approach, its two-stage design (20 + 80 pts) also provides maximum patient safety. This protocol conforms with the SPIRIT 2013 Statement. Ethics approval was granted by our but also 5 other university ethics committees (registration 473/18S)., Conclusion: Registration was performed prior to study initiation in November 2021 (registration number NCT05115929)., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 Published by Elsevier B.V. on behalf of EUROSPINE, the Spine Society of Europe, EANS, the European Association of Neurosurgical Societies.)

A 7-week-old girl presented with disseminated stage 4 neuroblastoma complicated with massive hepatomegaly and signs of liver failure. She underwent wedge liver biopsy and decompressive laparotomy with GORE-TEX® patch placement prior to the administration of chemotherapy. Her fluid losses during chemotherapy were so severe that her GORE-TEX® patch became tense and filled with ascites resulting in abdominal compartment syndrome (ACS). A negative pressure dressing system was applied after opening the patch to assist in the quantification of the fluid losses and to allow decompression. Unfortunately, in spite of favorable histology, the patient failed to adequately respond to chemotherapy resulting in persistent hepatomegaly. Soon after, she developed respiratory, renal insufficiency and disseminated intravascular coagulation, leading to her death 12 days after the initiation of treatment.

Background: Abdominal compartment syndrome (ACS) is a clinical entity that develops from progressive, acute increases in intra-abdominal pressure (IAP) and adversely affects all vital organ systems In this study, the development of intra-abdominal hypertension (IAH) and ACS in a surgical ICU population is described and examined. Methods: Over a one-year period (2004), urinary bladder pressure (UBP) was measured prospectively in all surgical patients with abdominal problems admitted to the ICU of the Imam Hospital complex. UBP of >20 cm H2O indicated IAH. ACS was defined as the development of multiple organ dysfunction including peak airway pressure (PAP) >50 cm H2O, Horowitz quotient