Abdominelles Kompartmentsyndrom im Kindesalter

The abdominal compartment syndrome in children is a rare but very severe clinical picture. Overall its occasion in children is rarely mentioned and described. Therefore first a review over this disease is given and after that the affected children are characterised in detail. The reports of all surgeries conducted at the University of Aachen in the years 1990-2005 were scanned retrospectively for children with laparostoma. Altogether only 35 children matched the appropriate criterions and their data could be used for the present study. On one hand the intention of this work was to characterise the affected children. This was done by presenting the age, the sex, the height, the weight, the pre-existing diseases, the former surgeries and the cause, that led to this disease. Further on the clinical progress should be presented. For that purpose the former surgeries, the necessary revisions and mesh-related complications, the time to definite abdominal closure, the lengths of hospital stay as well as the mortality were considered in detail. Beside a general survey it was differentiated between primary and secondary abdominal compartment syndrome and between different age groups (newborns, nurslings, toddlers, schoolchildren). Additionally the post-clinical development and the outcome of this disease were analysed. Information regarding these topics was collected with the help of a telephone questionnaire. As only very few reference data exists for children in literature a terminal comparison of the data of the present children and the children in literature with the data of adults was made. The abdominal compartment syndrome occured at every age and did not prefer a gender. The number of adipose children was above the average, a fact that was not known so far. More than 40% of the children possessed dysplasias. 9 of 14 children in their first year were early borns. Multiple but also many age-specific causes occurred. Multiple former abdominal surgeries seemed to pose a risk for the development of an abdominal compartment syndrome. 75% of the children needed only one following surgical operation after the initial decompression. The most complication in the region of the implanted mesh had been the fistula with 75%. The used closure techniques and lengths of clinical stay depended on the age. The total mortality was 23%, but varied largely between the different age groups between 11.11% and 60%. All together 60% of the fatalities occurred in the first 9 days after the decompression, where the first death in the group of the nurslings occurred on the 26th day. Out of the children in their first year only early borns died. None of the children needed a continuous medical care due to the decompression. Many children were disabled mentally or handicapped in their movements afterwards, but this could not be traced back to the decompression. Noticeable differences in contrast to adults were found among other things in the distribution of the sexes. In adults with 71% considerably more males were affected. The primary and secondary abdominal compartment syndrome seemed to possess a balanced distribution, whereas in children the primary abdominal compartment syndrome prevailed noticeably. The mortality of adults of 47% was much higher than the mean mortality of 43% of children in the literature. Here the mortality was only 23%, which can be explained partly by preventive decompressions and by the usage of vicryl meshes. Overall can be concluded, that the abdominal compartment syndrome is a rare but severe disease in children, that shall be investigated more in the future. Thereby primarily it has to be pointed out due to existing literature that this disease has to be made known, standardised methods of diagnostic and criterions for the diagnosis have to be figured out and established methods of therapy have to be uncovered. Further on the differentiated consideration of the different age groups is important especially in children, as many differences in the mortality, the number of former surgical operations or the dynamic of the mortality were observed in this work. Further on additional studies that illuminate the outcome of the affected children and possible consequences are desirable