Fasciotomy for Spontaneous Acute Compartment Syndrome in a Patient with Acquired Hemophilia A-A Case Report

Abstract

Background: The acute compartment syndrome is a limb-threatening condition and mostly associated with traumatic insults. Without an obvious history of injury nor in those with bleeding diathesis, it is often missed and delayed diagnosed, but frequently complicated by massive bleeding and neurovascular compromise. Materials and Methods: We present a rare case of acute compartment syndrome of the lower extremity due to spontaneous bleeding from acquired hemophilia A. The patient underwent fasciotomy and the postoperative course was complicated with massive bleeding from the wound bed. Blood components and factor VⅢ equivalents were administrated, and the wound was closed by a split-thickness skin graft thereafter. Results: Compartment syndrome of the legs in patients with acquired hemophilia A is hard to management and often misdiagnosed. Fasciotomy should be undertaken selectively and cautiously when the compartment pressure remains unstable or persistently high. Conclusion: Compartment syndrome from acquired hemophilia A is rarely reported. Constant bleeding from the fasciotomy site is a major complication, mandating frequent transfusions of blood and blood products. Early diagnosis and factor replacement may reduce the morbidity and result in better outcome.