Gluteal compartment syndrome: a case report

Abstract

IntroductionGluteal compartment syndrome is a rare, often unrecognized syndrome that may manifest as renal failure, sepsis, and death. Delay in diagnosis can result in significant morbidity and possible mortality. We report a case of occult gluteal compartment syndrome causing unresolving rhabdomyolysis.Case PresentationA 50-year-old Caucasian American man with history of chronic obstructive pulmonary disease was admitted status post fall and loss of consciousness for an unknown duration. Initial work-up revealed severe rhabdomyolysis, opioid abuse and acute renal failure. Inspite of three days of intensive therapy his condition did not improve and his renal failure worsened. On improvement of his condition three days later, he indicated some discomfort in his right hip. Physical examination was significant for swelling of the right gluteal region, which was tender and firm on palpation. A non-contrast CT scan showed evidence of gluteal compartment syndrome and emergent surgery resulted in significant improvement of his condition.ConclusionGluteal compartment syndrome most commonly occurs in individuals with altered mental status due to drugs or alcohol, who remain in one position for an extended period of time. This prolonged compression leads to muscle damage, edema, and a full-blown compartment syndrome. Due to its anatomic location and rarity, diagnosis is often missed or delayed, resulting in significant morbidity and possible mortality. The mainstay of treatment is fasciotomy.

Postoperative gluteal compartment syndrome following microsurgical free-flap hand reconstruction: the importance of early recognition and treatment

“…Examination will reveal worsening of the pain during passive movement of the hip, notably flexion and adduction, with weak active extension and abduction. Additional features suggesting compartment syndrome may include skin erythema or bruising, tense swelling of the buttocks and paraesthesia along the distribution of the sciatic nerve 5. As in our patient, moderate pain persisted after decompression of the gluteus maximus necessitating an epidural postoperatively.…”

“…Within the gluteal region, three fascial compartments exist5: (1) the gluteus maximus; (2) gluteus medius/minimus and (3) the tensor fascia lata. Each of these is held within its own fascial space.…”

Gluteal compartment syndrome caused by traumatic rupture of the superior gluteal artery

“…On the basis of our case and review of the literature, gluteal compartment syndrome must be considered as a serious complication of pelvic trauma, which might lead to fatal outcome [1][2][3][6][7][8][9][10]. The main stage of the treatment relates to prompt diagnosis and early surgery [10].…”

Acute gluteal compartment syndrome: superior gluteal artery rupture following a low energy injury

“…There are three distinct gluteal compartments: gluteus maximus, gluteus medius and minimus, and tensor fascia latae 12 13. The release of all these compartments is vital in the treatment of compartment syndrome in the gluteal region.…”

“…The release of all these compartments is vital in the treatment of compartment syndrome in the gluteal region. Studies have shown that ischaemia of 4 h duration can cause irretrievable muscle damage 12 14. This case shows that permanent muscle ischaemia (ie, muscle death) can occur before this allotted timeline and this in our case, was due to the high tamponading pressures caused by the arterial bleed.…”