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13 July 2019 : Case report  Japan

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

Unusual clinical course

Ryuta Itakura1ABCDEF, Natsuko Takayanagi2BCDE, Shingo Kobayashi1BCDF, Yoshio Sakurai1CD, Yoichi Iwamoto1CD, Hirotaka Ishido1CD, Koichi Moriwaki1CDE, Jun-ichi Tamaru2CD, Satoshi Masutani1ABCDEF*

DOI: 10.12659/AJCR.915296

Am J Case Rep 2019; 20:1011-1015

Abstract

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.

Keywords: Chromosome Aberrations, Disseminated Intravascular Coagulation, intra-abdominal hypertension, Sepsis, Child, Preschool, Fatal Outcome, Multiple Organ Failure

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923