Successful laparotomy for intra-abdominal hypertension following veno-venous extracorporeal membrane oxygenation after severe thoracoabdominal trauma: a case report.

Yo Huh, Jonghwan Moon, Kyoungwon Jung, Hye-Min Sohn
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Abstract

Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is often used as a life-saving therapy for lung injuries; however, it presents challenges, including bleeding risks and potential reductions in ECMO flow. This case report details the intricate management of a 16-year-old boy who suffered severe thoracoabdominal trauma following a nine-floor fall. The patient sustained severe lung injury and damage to multiple solid organs, including liver lacerations, and was placed on VV-ECMO. When initiating ECMO, it is crucial to carefully consider anticoagulation to avoid potential bleeding complications. Therefore, despite the usual risks associated with ECMO, such as bleeding and reduced flow rates, anticoagulation was withheld due to the risk of hemorrhage from the liver injury. While on ECMO support, the patient experienced a sudden decrease in flow and blood pressure, suggesting an increase in intra-abdominal pressure. An immediate decompressive laparotomy revealed a significant hemoperitoneum, primarily caused by oozing from the liver laceration. The prompt recognition of abdominal distension and the timely decision to proceed with surgery without further imaging were key to the successful treatment. Postoperatively, the patient showed good recovery, with gradual weaning from ECMO, extubation, and eventual discharge. In conclusion, this case highlights the importance of ongoing monitoring for patients with complex trauma who are on ECMO. External factors, including elevated intra-abdominal pressure, can impair ECMO performance. Meticulous management and a multidisciplinary approach are essential in these intricate cases, which involve the nonsurgical treatment of solid organ damage accompanied by severe lung injury.

严重胸腹外伤后静脉-静脉体外膜氧合后腹腔高压成功剖腹手术1例报告。
静脉-静脉(VV)体外膜氧合(ECMO)常被用作挽救肺损伤生命的治疗方法;然而,它带来了挑战,包括出血风险和ECMO流量的潜在减少。本病例报告详细介绍了一名16岁男孩的复杂处理,他在九楼坠落后遭受了严重的胸腹创伤。患者存在严重的肺损伤和多个实体器官损伤,包括肝脏撕裂,并给予VV-ECMO。当开始ECMO时,仔细考虑抗凝以避免潜在的出血并发症是至关重要的。因此,尽管存在与ECMO相关的常见风险,如出血和血流速率降低,但由于肝损伤出血的风险,抗凝治疗被搁置。在ECMO支持下,患者血流和血压突然下降,提示腹内压升高。立即剖腹减压术发现明显的腹膜出血,主要是由肝裂伤渗出引起的。及时识别腹胀并及时决定进行手术治疗是成功治疗的关键。术后,患者恢复良好,逐渐脱离ECMO,拔管,最终出院。总之,本病例强调了对正在进行ECMO的复杂创伤患者进行持续监测的重要性。外部因素,包括腹内压升高,可损害ECMO的表现。在这些复杂的病例中,包括实体器官损伤伴严重肺损伤的非手术治疗,细致的管理和多学科的方法是必不可少的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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