Lower leg compartment syndrome following prolonged orthopedic surgery in the lithotomy position -A case report-

Ahn, Ki Ryang; Park, Jin Hyung; Kim, Chun Sook; Kang, Kyu-Suk; Yoo, Sun Hong; Chung, Ji Won; Kim, Nan Seol; Lee, Seung Jin

doi:10.4097/kjae.2010.59.s.s49

Cited by 12 publications

(10 citation statements)

References 9 publications

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“…The necrosis of muscle cells and loss of capillary wall integrity then results in transudation and exudation, ending in massive edema within the muscle compartment [33]. The edema increases the pressure within the compartment, affecting the vascular supply and forming a vicious cycle [21, 34, 35]. Further, when surgical procedures are terminated, ischemia-reperfusion injury and the following localized tissue edema can result in a continued low perfusion state in the local tissue bed [30, 33].…”

Section: Discussionmentioning

confidence: 99%

Rhabdomyolysis after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Case Report

Bielen¹,

Verswijvel

Speeten³

2013

Case Rep Oncol

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Gastric cancer with peritoneal carcinomatosis is a disease with a poor prognosis. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal perioperative chemotherapy (HIPEC) can improve prognosis, although in most cases this should still be considered as a palliative treatment. Therefore, morbidity has to be avoided at all cost as quality of life is of utmost importance. We describe the case of a 64-year-old female with an adenocarcinoma of the stomach that was initially treated with a Billroth II gastrectomy, adjuvant chemotherapy and radiotherapy. During follow-up, the diagnosis of peritoneal carcinomatosis was made, and the patient was referred for CRS and HIPEC. Postoperatively, she developed rhabdomyolysis in both gastrocnemius muscles. Renal function remained within normal limits, but ultrasonography of the lower legs suggested the presence of bilateral abscesses. Drainage with pigtail catheters was necessary for more than 1 month, significantly impairing quality of life. The objective of this case report is to heighten awareness for this complication. Rhabdomyolysis is a rare complication of CRS and HIPEC, with a significant impact on quality of life. Prevention is necessary and can be achieved by adequate surgical positioning, using the altered lithotomy position, sufficient padding and by preventing hypovolemia.

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Section: Discussionmentioning

confidence: 99%

Rhabdomyolysis after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Case Report

Bielen¹,

Verswijvel

Speeten³

2013

Case Rep Oncol

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“…The vascular complications include thromboembolism 5 and, although rare, the dreaded compartment syndrome. 6 The common neurologic complications are neuropathies of the femoral, 7-9 sciatic, 10,11 and the peroneal nerves. 12 Similar to our cases, Kishor Choudhari et al reported a case of acute central disc prolapse at the L4/5 level superimposed on a mild degree of congenital spinal stenosis following vaginal hysterectomy in the lithotomy position.…”

Section: Discussionmentioning

confidence: 99%

Acute Lumbar Disc Prolapse: A Rare Complication of Lithotomy Position

SinghNisha

MeenakshiJohri

NegiNeha

2015

Journal of Gynecologic Surgery

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Background: Lithotomy is a common position in various gynecologic, urologic, orthopedic, colorectal, and pediatric surgeries. Neurovascular injuries described with the lithotomy position depend on the degree of lithotomy, type of surgery, and duration of surgery. These injuries include aseptic necrosis of femur head, ligamentous relaxation of the back, peroneal nerve injury, tibial nerve injury, vessel compression, compartment syndrome, compression ulcers, and disc prolapse. In this study, we report two rare cases of acute lumbar intervertebral disc prolapse following surgery for uterovaginal prolapse. Cases: A 35-year-old P2 + 0 with thirddegree cervical elongation underwent Fothergill operation, and a 52-year-old postmenopausal woman with thirddegree uterovaginal prolapse underwent Ward Mayo's hysterectomy, both under spinal anesthesia. There were no other comorbidities and both were found to be absolutely fit in the preanesthesia assessment before surgery. The procedures lasted for 90 and 100 minutes, respectively, and were uneventful. On the fifth and third postoperative day, they complained of low backache, pain radiating to the lateral aspect of both the lower limbs, and weakness in both lower limbs. Contrast MRI of the lumbosacral spine showed disc protrusion at the L5-S1 level in both cases. They were managed conservatively with the use of lumbosacral belt and spinal extension exercises. Both patients symptomatically improved and regained full strength and reflexes in both the lower limbs over a period of 3 months. Conclusions: Apart from detailed history and examination during preoperative evaluation, one must be careful while positioning the patient in lithotomy for any surgery. The process of positioning should be smooth and simultaneous bilaterally to avoid neuropathies. In the postoperative period, MRI should be done to exclude disc prolapse if the patient's signs and symptoms suggest so. Most patients can be treated conservatively. ( J GYNECOL SURG 31:367)

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“…[ 3 ] The overwhelming majority of WLCS report is associated with urological, gynecological, and orthopedic surgeries. [ 4 5 ] In fact, WLCS usually occurs after the patient is placed in lithotomy position for prolonged operating hours. Interestingly, our patient was in supine position during the surgery time, a very rare complication.…”

Section: Discussionmentioning

confidence: 99%

Can intermittent pneumatic compression cause compartment syndrome?

et al. 2018

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We report a case of a 32-year-old male patient who developed unilateral lower-limb compartment syndrome following a long surgical procedure during which intermittent pneumatic compression was used as deep-venous thrombosis prophylaxis. This complication of surgery is associated with significant morbidity. Previously published reports have suggested the possible risk factors and a way to reach a diagnosis at an early stage. The possible risk factors we present are the long operative time and the use of intermittent pneumatic compression as deep-vein thrombosis prophylaxis. These findings could be used to raise awareness in early diagnosis and treatment.

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Lower leg compartment syndrome following prolonged orthopedic surgery in the lithotomy position -A case report-

Cited by 12 publications

References 9 publications

Rhabdomyolysis after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Case Report

Rhabdomyolysis after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Case Report

Acute Lumbar Disc Prolapse: A Rare Complication of Lithotomy Position

Can intermittent pneumatic compression cause compartment syndrome?

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