Abstract
Acute Compartment Syndrome is an Orthopedic emergency which if not recognized and treated in time can lead to serious irreversible damage to neuromuscular structures.We are reporting here a case of Acute Compartment Syndrome of the right leg in an adult male patient following a prolonged urological surgery - 5 hours in the lithotomy position. Post Operative Patients symptoms and signs were diagnosed early and an urgent Fasciotomy was done which relieved him of his symptoms and averted major damage to his leg. Acute Compartment Syndrome of the leg is a recognized but rare iatrogenic complication in many Prolonged Urological procedures due to lithotomy position used in them. If prolonged urological procedure is necessary patient should be monitored post operatively for early and prompt treatment of this complication. Early diagnosis and prompt treatment is the main-stay of the treatment in cases of Acute Compartment Syndrome following unavoidable prolonged urological procedures in lithotomy position. We recommend a written consent and information to the patient regarding the risk of the above. In our case urgent decompression by four compartment fasciotomy was successful and averted all disabling complications.
Highlights
Acute compartment syndrome (ACS) is an orthopedic emergency which if not recognized and treated in time can lead to serious irreversible damage to neuromuscular structures
Pfeffer et al showed that the lithotomy position is associated with changes in intracompartment pressure that are dependent on the method of leg support used [4]
Increase in intra-compartment pressure during surgery in the lithotomy position with the calf or knee supported may be one of the factors that contribute to the development of compartment syndrome
Summary
The original description of compartment syndrome was by Richard von Volkmann in 1872 [1] He described contractures of the forearm muscles following tight bandaging for reduction of an elbow fracture. Acute compartment syndrome is a painful condition, due to the pressure within the muscles that builds up to dangerous levels. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching the nerve and muscle cells. Post-operatively the patient complained of pain and swelling in the right calf muscles (Figure 2). Patient was urgently taken to the operation theatre and a four compartment fasciotomy of the right leg was done (Figure 3). On his last follow up patient had regained good power of dorsiflexion of his ankle and his sensations of the foot has improved
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