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

Ryuta Itakura, Natsuko Takayanagi, Shingo Kobayashi, Yoshio Sakurai, Yoichi Iwamoto, Hirotaka Ishido, Koichi Moriwaki, Jun-ichi Tamaru, Satoshi Masutani

(Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan)

Am J Case Rep 2019; 20:1011-1015

DOI: 10.12659/AJCR.915296

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.

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