Recurrent spontaneous compartment syndrome of the thigh

Abstract

Acute comparment syndrome (ACS) is a surgical emergency, in which tissue pressure becomes greater than perfusion pressure leading to tissue ischaemia. It is typically a consequence of trauma. We present a case in which a patient suffers blunt trauma to the thigh, but develops ACS 2 years after this injury and consequently endures 10-episodes of ACS (no perciptating event or cause) in the same thigh over 10 years. On the 10th presentation the patient was found to have arteriovenous malformation on MR angiography which were embolised and the fasciotomy wound closed with a split-thickness skin graft. A thorough literature search deemed this case to be the first reported recurrent spontaneous ACS of the thigh. Prompt recognition and treatment of ACS is vital. Clinicians should thoroughly investigate such patients postoperatively and involve vascular/plastic surgeons and interventianal radiologist to provide optimum care and prevent recurrence.

Unusual Presentation of Compartment Syndrome

“…Vascular abnormalities such as arteriovenous malformations and fistulae can be the cause for hematoma formation and recurrent compartment syndrome. Such case was reported in the thigh of a 31-year-old fit and well male from Bournemouth who suffered ten times recurrent ACS of his thigh [30]. MR angiography at the last occurrence depicted abnormal vessels arising from profunda and superficial femoral arteries which have been embolized.…”

Spontaneous acute forearm compartment syndrome: Case report of a clinical diagnosis with limited imaging options

“…[1 , 7] . ACS can occur several months or even years after the trauma [8] . Idiopathic spontaneous ACS is an uncommon occurrence [3 , 4] .…”

Acute anterior thigh compartment syndrome in Premiership rugby

“…Occurrences of ACS within sport are rare 2 10. There is a paucity of examples associated with the anterior thigh2 4–7 and none previously of a professional rugby player which have been published within empirical research. Commonly, previously published cases investigate ACS from a mechanical12 and clinical perspective.…”

“…Commonly, ACS aetiology is associated with compartments of the lower leg and forearm (with or without fractures) following direct trauma 2. However, isolated occurrences to the thigh have been noted2 4–7; even though the thigh contains a larger compartment encapsulated with dilative fascia and the anatomy of the hip naturally facilitates tissue expansion 8. Alternatively, instances of ACS have also been induced by exercise, known as exercise-induced compartment syndrome 9.…”