Bilateral acute lower limb compartment syndrome necessitating emergency fasciotomy after total laparoscopic hysterectomy in the lithotomy position with head-down tilt: A case report

Abstract

Acute lower limb compartment syndrome may develop after pelvic surgery performed in the lithotomy position.Accurate diagnosis is based on clinical suspicion, and postoperative leg pain may serve as a red flag sign of this condition. Early diagnosis and treatment improve prognosis; therefore, prompt intervention is important in patients showing a high index of clinical suspicion for this syndrome. We report a case of bilateral acute lower limb compartment syndrome in a 43-year-old woman, following total laparoscopic hysterectomy with bilateral salpingo-oophorectomy.The operative time was 5 hours and 10 min in this patient who was placed in the lithotomy position with a head-down tilt. The total intraoperative blood loss was 75 g, and the patient's blood pressure was low throughout the operation. We suspected this condition based on bilateral calf swelling/pain, and the patient underwent blood tests and contrastenhanced computed tomography, which revealed bilateral lower limb muscle ischemia, and we diagnosed the patient with lower limb compartment syndrome and performed emergency fasciotomy. The patient was discharged on postoperative day 25 and has shown good recovery without any complications. Even mild postoperative leg pain may be an early sign of acute lower limb compartment syndrome; therefore, early identification of high-risk patients and close 24-hour postoperative monitoring are warranted in such cases.