Peritoneal Drainage As a Safe Alternative to Laparotomy in Children with Abdominal Compartment Syndrome

Context: Abdominal compartment syndrome in children carries a mortality of 40–60%. Although definitive treatment for this condition traditionally involves decompressive laparotomy, percutaneous catheter drainage of associated ascites is described as an alternative to laparotomy in adults. Aims: We explored the safety and efficacy of percutaneous catheter drainage of intraabdominal fluid for reversing abdominal compartment physiology in a critically-ill cohort of small children. Materials and Methods: We reviewed records of all children undergoing percutaneous catheter drainage for abdominal compartment syndrome from 2014 to 2018 in a single institution, excluding those who required drainage for other indications. Bedside sonogram-guided drainage using Seldinger technique or Penrose drain placement was performed by the pediatric surgical service, with drains removed on the resolution of compartment syndrome physiology and fluid output of <10 mL/day. Primary outcome measures were improvement in compartment physiology over 24 h. Statistical Analysis: Data were analyzed using descriptive statistics and paired Wilcoxon signed-rank tests. Statistical significance was assumed at P < 0.05. Results: Ten children ranging from 1.1 kg to 38 kg underwent 11 percutaneous catheter drainage procedures for abdominal compartment syndrome secondary to blood, serous fluid, air, or a combination. Significant physiologic improvement was seen across multiple variables including pulse rate, pH, and lactate. No patients later required decompressive laparotomy. Four patients died due to their primary disease. Conclusion: Percutaneous catheter drainage is safe and efficacious in reversing abdominal compartment physiology in children with intraabdominal fluid, and can be considered prior to surgical intervention when clinically appropriate.