Abdominal compartment syndrome in the pediatric population – Case series and review of the literature

Introduction: Abdominal compartment syndrome (ACS) in children is a rare but life-threatening condition caused by increased intra-abdominal pressure leading to multi-organ dysfunction. Despite its severity, pediatric ACS remains underrecognized, with limited data available to guide diagnosis and management. Aim: This study aims to contribute to the scarce literature by summarizing our institutional experience in diagnosing and managing pediatric ACS. Methods: A retrospective review was conducted of all patients under 18 years who underwent decompressive laparotomy for ACS between 2014 and 2024 at a single tertiary pediatric center. Data included demographics, underlying conditions, surgical details, and clinical outcomes. Results: Nine children, aged one week to seven years, were diagnosed with ACS and treated surgically. Etiologies varied and included postoperative complications, sepsis, and congenital anomalies such as Hirschsprung's disease, cyanotic congenital heart disease, and imperforate anus. Surgical approaches included decompressive laparotomy with or without bowel resection and open abdomen management using a Bogota bag. Despite intensive care, the mortality rate exceeded 50 % (5/9 patients). Conclusions: Pediatric ACS is a heterogeneous condition with limited published data and significant mortality. Improved awareness, early recognition of warning signs, and timely surgical decompression are critical to improving outcomes in this vulnerable population.