• Bobbi Jo Morrell, Christopher Vinden, Ram N Singh, Alik Kornecki, and Douglas D Fraser.
• Department of Anesthesiology and Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, London, ON.
• Pediatr Crit Care Me. 2007 Jan 1; 8 (1): 67-70.

ObjectiveTo report a rare case of secondary abdominal compartment syndrome during shock resuscitation in a pediatric trauma patient.DesignCase report and literature review.SettingA community hospital and a designated children's trauma hospital.PatientA 17-yr-old trauma patient.InterventionsAdvanced trauma life support, trauma laparotomy, and superficial temporal artery ligation.Measurements And Main ResultsA 17-yr-old trauma patient with ongoing blood loss from a lacerated superficial temporal artery received aggressive crystalloid resuscitation before arrival at a designated trauma hospital. His injury severity score was 16. The first hemoglobin drawn was 55 g/L with a hematocrit of 0.16 L/L. Within 3 hrs of the trauma, an abdominal computed tomography scan demonstrated a moderate amount of free peritoneal fluid, edematous bowel with marked enhancement, and a compressed inferior vena cava. Shortly after completion of imaging studies, the patient's abdomen became increasingly tense with poor perfusion to the lower extremities. Urgent laparotomy for abdominal compartment syndrome identified excessive ascites and extensive bowel edema with no blood or traumatic injuries. Abdominal decompression resulted in immediate improvement of hemodynamics and restored lower limb perfusion. Primary abdominal closure was obtained and the patient recovered fully with gentle diuresis.ConclusionsSecondary abdominal compartment syndrome developed in this pediatric trauma patient with hemorrhagic shock, possibly from aggressive crystalloid resuscitation. This trauma case highlights the importance of early hemorrhagic control with balanced crystalloid/transfusion therapy. Secondary abdominal compartment syndrome in pediatric trauma is rare and may reflect physiologic differences during development, less aggressive resuscitation practices, and/or underrecognition.

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