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A 5-week old infant with a PMH of congenital chloride diarrhea, a rare genetic disorder causing secretory diarrhea, presents with acute (over the last few hours) absence of previously frequent loose stools, 3 episodes of non-bilious vomiting, and progressive abdominal distension. On exam the infant’s abdomen is markedly tense with evidence of abdominal wall rigidity. The infant is also hypoventilatory and shows signs of poor perfusion. Bedside iStat shows severe lactic acidosis.
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April 28, 2026 at 11:10 pm
D) Decompressive laparotomy
Pediatric abdominal compartment syndrome is a rare life-threatening condition requiring urgent decompressive laparotomy. It can result from a variety of underlying causes including: trauma, peritonitis / intra-abdominal sepsis, prior surgical conditions (e.g. omphalocele, NEC, congenital diaphragmatic hernia, congenital megacolon), infectious enterocolitis, and even chronic constipation. It presents with a tense distended abdomen. In adults, it is defined as intra-abdominal pressured > 20 mm Hg, but there is no clear cutoff for pediatric patients. Instead, pediatric ACS is characterized by distended abdomen + signs of organ dysfunction such as hemodynamic instability, respiratory failure, and oliguria. When suspected, a surgeon should be involved in the patient’s care immediately. This case was adapted from: PMID: 40934843