Recommended Citation
Aker U, Gamero Kubota P, Patton T. From Chronic Constipation to Abdominal Compartment Syndrome: A Pediatric GI Perspective. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
Chronic constipation is one of the most common pediatric complaints and accounts for 1/4 of pediatric GI consults. It affects approximately 12-18% of individuals between 0 to 18 years of age. Although outcomes are generally positive with appropriate management including dietary changes, laxatives, and medications such as linaclotide, undiagnosed or inadequately treated constipation could have detrimental results. Abdominal compartment syndrome (ACS) due to fecal impaction is a considerably rare complication of constipation. We present the exceptional case of an adolescent who developed ACS secondary to severe constipation and required prolonged intensive care admission.
Description:
A 17-year-old male with a history of constipation was brought to the ED due to severe abdominal pain and non-bilious, non-bloody vomiting for 1 day. He had been followed by GI six years prior but was lost to follow-up. At admission, he was found to have severe hyperkalemia due to acute kidney injury. He subsequently developed bradyarrhythmia and cardiac arrest, requiring 90 minutes of resuscitation. Bedside laparotomy revealed a massively dilated colon filled with stool. Fecal disimpaction and temporary abdominal closure were performed. Progressive ischemia in the following days prompted total colectomy with end ileostomy. Pathology showed no Hirschsprung disease or structural abnormalities. Testing for celiac disease and inflammatory bowel disease was negative. His course was complicated by acute heart failure, acute kidney injury, pleural effusions, ascites, and femoral deep vein thrombosis. He later developed recurrent abdominal pain with pneumatosis. After months of recovery and improved oral intake and weight gain, he was ultimately ready for discharge with multidisciplinary care and close follow up.
Discussion:
This case highlights ACS as a catastrophic but preventable complication of pediatric constipation. Timely surgical intervention saved the patient’s life, while gastroenterology played a critical role in nutritional rehabilitation and evaluation for the etiology of his constipation. Constipation is often treated conservatively with minimal intervention. However, this case demonstrates that constipation can have life-threatening consequences if not addressed appropriately. For this reason, constipation must be followed closely, and management should be escalated as indicated. The cause of his constipation remains unknown, emphasizing the need for thorough evaluation of this condition.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Poster
Open Access
Available to all.
From Chronic Constipation to Abdominal Compartment Syndrome: A Pediatric GI Perspective
Background/Significance:
Chronic constipation is one of the most common pediatric complaints and accounts for 1/4 of pediatric GI consults. It affects approximately 12-18% of individuals between 0 to 18 years of age. Although outcomes are generally positive with appropriate management including dietary changes, laxatives, and medications such as linaclotide, undiagnosed or inadequately treated constipation could have detrimental results. Abdominal compartment syndrome (ACS) due to fecal impaction is a considerably rare complication of constipation. We present the exceptional case of an adolescent who developed ACS secondary to severe constipation and required prolonged intensive care admission.
Description:
A 17-year-old male with a history of constipation was brought to the ED due to severe abdominal pain and non-bilious, non-bloody vomiting for 1 day. He had been followed by GI six years prior but was lost to follow-up. At admission, he was found to have severe hyperkalemia due to acute kidney injury. He subsequently developed bradyarrhythmia and cardiac arrest, requiring 90 minutes of resuscitation. Bedside laparotomy revealed a massively dilated colon filled with stool. Fecal disimpaction and temporary abdominal closure were performed. Progressive ischemia in the following days prompted total colectomy with end ileostomy. Pathology showed no Hirschsprung disease or structural abnormalities. Testing for celiac disease and inflammatory bowel disease was negative. His course was complicated by acute heart failure, acute kidney injury, pleural effusions, ascites, and femoral deep vein thrombosis. He later developed recurrent abdominal pain with pneumatosis. After months of recovery and improved oral intake and weight gain, he was ultimately ready for discharge with multidisciplinary care and close follow up.
Discussion:
This case highlights ACS as a catastrophic but preventable complication of pediatric constipation. Timely surgical intervention saved the patient’s life, while gastroenterology played a critical role in nutritional rehabilitation and evaluation for the etiology of his constipation. Constipation is often treated conservatively with minimal intervention. However, this case demonstrates that constipation can have life-threatening consequences if not addressed appropriately. For this reason, constipation must be followed closely, and management should be escalated as indicated. The cause of his constipation remains unknown, emphasizing the need for thorough evaluation of this condition.
Affiliations
Advocate Children Hospital Oak Lawn