Tetsuhara Kenichi, Tsuji Satoshi, Tomonaga Kotaro
Division of Pediatric Emergency and Transport Services, National Center for Child Health and Development, Tokyo, Japan.
Division of Surgery, National Center for Child Health and Development, Tokyo, Japan.
BMJ Case Rep. 2019 Jul 11;12(7):e229198. doi: 10.1136/bcr-2019-229198.
Abdominal compartment syndrome (ACS) is not rare and has a high mortality in the paediatric intensive care unit. However, there are few reports about this in the emergency department (ED). We report an 8 month-old male patient with ACS in shock associated with gastric volvulus who improved rapidly by a simple procedure in the ED. He had congenital comorbidities, including multiple cranial anomalies and was transferred because of decreased mental status. He had compensated shock with cold and mottled skin of the lower extremities, paediatric Glasgow Coma Scale of E3V5M6 and prominence of the left upper abdomen. The abdominal X-ray showed a considerably distended stomach. Soon after aspiration of gastric contents, shock and mental status improved. Physicians should consider ACS in the differential diagnosis of shock with abdominal distention. ACS may be ameliorated by gastric suction. Gastric volvulus can induce shock and decreased mental status, particularly in patients with comorbidities.
腹腔间隔室综合征(ACS)在儿科重症监护病房并不罕见,且死亡率很高。然而,急诊科(ED)关于此病症的报道较少。我们报告一例8个月大的男性ACS患者,其休克与胃扭转相关,在急诊科通过一个简单的操作迅速好转。他患有先天性合并症,包括多种颅骨异常,因精神状态下降而被转诊。他处于代偿性休克状态,下肢皮肤冰冷且有花斑,小儿格拉斯哥昏迷量表评分为E3V5M6,左上腹突出。腹部X线显示胃明显扩张。抽出胃内容物后不久,休克和精神状态得到改善。医生在鉴别诊断伴有腹胀的休克时应考虑ACS。通过胃吸引可能改善ACS。胃扭转可诱发休克和精神状态下降,尤其是在合并症患者中。