Practical Pearl

Neurocritical Care

, Volume 15, Issue 3, pp 516-518

First online:

Decompressive Laparotomy for Refractory Intracranial Hypertension After Traumatic Brain Injury

  • Jon D. DorfmanAffiliated withDepartment of Surgery, Boston University School of Medicine and Boston Medical Center
  • , Joseph D. BurnsAffiliated withDepartment of Neurology, Boston University School of Medicine and Boston Medical CenterDepartment of Neurosurgery, Boston University School of Medicine and Boston Medical Center Email author 
  • , Deborah M. GreenAffiliated withDepartment of Neurology, Boston University School of Medicine and Boston Medical CenterDepartment of Neurosurgery, Boston University School of Medicine and Boston Medical Center
  • , Christina DeFuscoAffiliated withDepartment of Neurology, Boston University School of Medicine and Boston Medical Center
  • , Suresh AgarwalAffiliated withDepartment of Surgery, Boston University School of Medicine and Boston Medical Center

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Abstract

Background

Intracranial hypertension is a crucial modifiable risk factor for poor outcome after traumatic brain injury (TBI). Limited evidence suggests that decompressive laparotomy may be an effective treatment for refractory ICH in patients who have elevated intra-abdominal pressure.

Methods

Case report.

Results

We present a multi-trauma patient who sustained severe TBI in a motor vehicle collision. Intracranial pressure (ICP) was initially medically managed but became refractory to standard therapies. Emergent decompressive laparotomy performed in the surgical intensive care unit for abdominal compartment syndrome concomitantly improved the patient’s ICP.

Conclusions

Elevated intra-abdominal pressure can exacerbate intracranial hypertension in patients with TBI. Recognition of this condition and treatment with decompressive laparotomy may be useful in patients with intracranial hypertension refractory to optimal medical therapy.

Keywords

Traumatic brain injury Intracranial hypertension Intra-abdominal hypertension