Abdominal Compartment Syndrome

Abdominal compartment syndrome is a critical concern in the management of congenital abdominal wall defects, particularly giant omphalocele and gastroschisis. Monitoring intra-abdominal pressure during and after closure is essential, with ventilatory parameters serving as the most reliable measure of safe closure tension [e639-c33, e1059-c24]. Bladder pressure measurement, though standard practice at some centers for 24 hours post-closure, has questioned reliability in tiny newborns [e639-c34, e1059-c23]. Intragastric pressure via NG tube offers an easy intraoperative guide, with 20 mmHg suggested as a threshold; pressures of 12 mmHg with a stable baby provide reassurance, while 35-40 mmHg raises concern even if the baby appears stable [e639-c35, e639-c36, e1059-c22]. Complications of primary gastroschisis closure stem mainly from increased abdominal pressure leading to decreased venous return and possible abdominal compartment syndrome with ischemic injury . In older children with giant omphalocele, rapid reduction can cause abdominal compartment syndrome and death; time must be allowed for abdominal domain expansion, with staged enlargement of the fascial defect over 2-3 stages preventing forced reduction [e639-c39, e1059-c25, e1059-c26]. Novel traction-assisted closure devices have shown promise: complete fascial closure was achieved after a median of 7 days in giant omphalocele and 5 days in complicated gastroschisis, with no patients developing abdominal compartment syndrome [e9436-c3, e9436-c4, e9436-c5, e10554-c6, e10554-c7, e10554-c8].