Secondary abdominal compartment syndrome in patients with toxic epidermal necrolysis |
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Authors: | Struck Manuel Florian Illert Till Schmidt Thomas Reichelt Beate Steen Michael |
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Affiliation: | Department of Plastic and Hand Surgery, Burn Trauma Center, Bergmannstrost Hospital, Merseburger Str. 165, 06112 Halle/Saale, Germany. manuelstruck@web.de |
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Abstract: | IntroductionSecondary abdominal compartment syndrome (ACS) is a severe complication in patients admitted to burn intensive care units (BICUs). Unlike patients with thermal burns, patients with toxic epidermal necrolysis (TEN) present with a different pathophysiology and usually require less fluid.Patients and methodsWe reviewed our registry of adult patients presenting with TEN in our 8-bed BICU over the course of 11 years and identified and analyzed patients treated for ACS and decompressive laparotomy (DL).ResultsFrom a total of 29 patients with bioptic confirmed TEN, 5 underwent DL due to ACS with a mean age of 57 years, mean percentage of total body surface area (TBSA) affected of 54 ± 25%, complete epidermolysis of 28 ± 24% TBSA, a mean severity of illness score (SCORTEN) of 3.8 ± 0.8, and a mean intra-abdominal pressure before DL of 33 ± 7 mmHg. Mortality was 100% in patients with ACS versus 33% without ACS.ConclusionAn ACS that requires DL worsens the already critical condition of a TEN patient considerably. TEN-related impaired intestinal functionality and increasing intestinal edema due to systemic capillary leakage warrant early initiation of intra-abdominal pressure monitoring to identify patients at high risk of ACS. |
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Keywords: | Adverse drug reactions Toxic epidermal necrolysis Abdominal compartment syndrome Decompressive laparotomy |
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