Abdominal compartment syndrome complicating necrotizing enterocolitis: A case report

INTRODUCTION: There are several disease entities subsumed under the heading Necrotizing Enterocolitis (NEC): 1: The infectious enterocolitis that causes bowel necrosis. 2: Spontaneous Intestinal Perforation which is linked to the use of Indocin to hasten closure of a patent ductus arteriosus (PDA); the perforation occurs in bowel that is well perfused and viable. 3: Perforations that occur in bowel that is obstructed by thick or inspissated meconium (Awolaran and Sheth, Sept 2021) [1]. 4: The uncommon variant that is associated with the abdominal compartment syndrome. CASE REPORT: A case is presented in which a preemie suddenly developed massive abdominal distension. The neonatologist embarked upon the usual work-up and therapeutic interventions but was stymied by the inability to pass an orogastric tube to relieve the abdominal distension. DISCUSSION: The purpose of this report is not to criticize the neonatologist, but to emphasize the difference between this case, complicated by the abdominal compartment syndrome, and the usual case of NEC. CONCLUSION: This is an unusual manifestation of NEC; and in my experience, it is uniformly fatal. Like many diseases with a fulminant course, our therapeutic efforts seem always too little, too late. Perhaps, by calling attention to this unusual association, its dismal outcome may be altered.