Forearm Compartment Syndrome of a Newborn Associated with Extravasation of Contrast Agent

Abstract

Extravasation of contrast agents is a possible complication of imaging studies. Although extravasations typically cause minimal swelling or erythema, they can lead to compartment syndrome when the volume of extravasation is high. In this article, we will present an exceptional case where an insignificant amount of contrast agent extravasation led to a forearm compartment syndrome in a newborn, who was treated with an extended fasciotomy. We would like to emphasize the preventive techniques and treatment options of this iatrogenic complication in newborns. Close followup of the patient by the nurses, awareness of the parents and the personnel in the radiology department are the most important preventive measures in this extremity-threatening complication. Forearm compartment syndrome due to contrast agent extravasation may progress more rapidly in newborns even with smaller amounts of extravasation and prompt recognition of the pathology and immediate intervention are unevitable.

Complete Decompression of a Forearm Neonatal Compartment Syndrome Using a Volar Approach: A Surgical Technique

“…17 In other cases, complete recovery of the hand and wrist has been reported. 8,13 The sequelae of NCS are typically mitigated by emergent fasciotomy with decreased time from presentation to intervention. In several cases where complete recovery was achieved, operative intervention occurred within 24 hours of initial presentation.…”

“…In several cases where complete recovery was achieved, operative intervention occurred within 24 hours of initial presentation. 8,12 Though early suspicion and management do not always guarantee complete function restoration, urgent decompressive fasciotomy is warranted to optimize patient prognosis and alleviate the need for ancillary reconstructive surgeries. Nanda et al 17 presented a patient with NCS in whom fasciotomy was performed at 12 hours of life; however, the autoamputation of the thumb at the interphalangeal joint occurred by 6 months of age, and significant shortening of the radius later in life.…”

“…3,8,11,17,18 Albeit drastic to perform on a neonate, the benefits of fasciotomy over conservative management of NCS have been well-documented. 8,13 This aggressive treatment has been shown to limit the extensive loss of motor and sensory function, and prevent radial and ulnar shortening that stem from physeal growth arrest in the setting of nonoperative treatment. 5,9,14,25…”

“…Common exposures to upper extremity decompressive fasciotomy include the classic volar-Henry approach, as well as the volar curvilinear, anterolateral and posteromedial, volar and dorsal forearm, and anterolateral forearm incisions. 8,11,[15][16][17][18] However, all these approaches result in the exposure of tendons and neurovascular structures, leading to potential postoperative nerve complications, poor soft-tissue coverage, esthetic complications, and need for multiple surgeries. 19,20 Herein, using a single volar incision, we describe a modified McConnell surgical approach that was performed on a neonate to release all his 3 forearm compartments while attempting at preventing the disease's progression toward complete limb ischemia.…”

Báo cáo ca bệnh: Hội chứng chèn ép khoang ở trẻ sơ sinh

“…Hơn nữa, các co rút do thiếu máu cục bộ giai đoạn cuối có thể cần các phẫu thuật tái tạo và thường có tiên lượng xấu. 3 Hội chứng chèn ép khoang ở trẻ sơ sinh là một chẩn đoán hiếm gặp, với gần 100 trường hợp đã được báo cáo trong y văn. Căn nguyên vẫn chưa được hiểu một cách rõ ràng và kinh nghiệm điều trị trong thực hành lâm sàng còn hạn chế.…”