Case report of successful management of open abdomen due to abdominal compartment syndrome in a patient with neuroblastoma stage 4S using the Fasciotens Pediatric® System

Introduction and importance: Abdominal compartment syndrome (ACS) due to metastatic hepatomegaly is a rare condition in pediatric patients. While decompressive laparotomy remains the treatment of choice for ACS, long-term stabilization of critically ill patients with an open abdomen, as well as secondary closure of the abdominal wall remains challenging regarding further oncological treatment. Presentation of case: We present a 2.5-month-old female infant with neuroblastoma stage 4S and ACS due to hepatic metastases and massive hepatomegaly. The patient achieved stabilization after several surgeries via open abdomen therapy. Gradual expansion of the abdominal wall in preparation for secondary abdominal wall closure was achieved using a Gore-Tex® patch in combination with the Fasciotens Pediatric® System. Clinical discussion: Intensive interdisciplinary care is essential for the management of infants with ACS resulting from metastatic hepatomegaly. While the stabilization of these patients already poses a significant challenge, additional difficulties arise from the need to continue oncological treatment, as well as the complex considerations surrounding abdominal wall closure. Conclusion: This case demonstrates that vertical traction using the Fasciotens Pediatric® system may support safe open abdomen management in infants with ACS due to metastatic neuroblastoma and can facilitate subsequent continuation of oncological therapy.