scholarly journals Delayed Presentation of Gluteal Compartment Syndrome: The Argument for Fasciotomy

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
John E. Lawrence ◽  
Duncan J. Cundall-Curry ◽  
Kuldeep K. Stohr
Keyword(s):  
Compartment Syndrome ◽  
Kidney Injury ◽  
Limb Ischaemia ◽  
Delayed Presentation ◽  
Neurological Improvement ◽  
Tertiary Centre ◽  
Acute Limb Ischaemia ◽  
Nerve Recovery ◽  
The Right ◽  
Gluteal Compartment Syndrome

A male patient in his fifties presented to his local hospital with numbness and weakness of the right leg which left him unable to mobilise. He reported injecting heroin the previous morning. Following an initial diagnosis of acute limb ischaemia the patient was transferred to a tertiary centre where Computed Tomography Angiography was reported as normal. Detailed neurological examination revealed weakness in hip flexion and extension (1/5 on the Medical Research Council scale) with complete paralysis of muscle groups distal to this. Sensation to pinprick and light touch was globally reduced. Blood tests revealed acute kidney injury with raised creatinine kinase and the patient was treated for rhabdomyolysis. Orthopaedic referral was made the following day and a diagnosis of gluteal compartment syndrome (GCS) was made. Emergency fasciotomy was performed 56 hours after the onset of symptoms. There was immediate neurological improvement following decompression and the patient was rehabilitated with complete nerve recovery and function at eight-week follow-up. This is the first documented case of full functional recovery following a delayed presentation of GCS with sciatic nerve palsy. We discuss the arguments for and against fasciotomy in cases of compartment syndrome with significant delay in presentation or diagnosis.

scholarly journals A case report of multisite arterial thrombosis in a patient with coronavirus disease 2019 (COVID-19)

2020 ◽  
Author(s):  
Marco Angelillis ◽  
Marco De Carlo ◽  
Andrea Christou ◽  
Michele Marconi ◽  
Davide M Mocellin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Case Report ◽  
Arterial Thrombosis ◽  
Leg Pain ◽  
Nasopharyngeal Swab ◽  
Limb Ischaemia ◽  
Total Occlusion ◽  
Left Common Iliac Artery ◽  
Acute Limb Ischaemia ◽  
The Right

Abstract Background A systemic coagulation dysfunction has been associated with COVID-19. In this case report, we describe a COVID-19-positive patient with multisite arterial thrombosis, presenting with acute limb ischaemia and concomitant ST-elevation myocardial infarction and oligo-symptomatic lung disease. Case summary An 83-year-old lady with history of hypertension and chronic kidney disease presented to the Emergency Department with acute-onset left leg pain, pulselessness, and partial loss of motor function. Acute limb ischaemia was diagnosed. At the same time, a routine ECG showed ST-segment elevation, diagnostic for inferior myocardial infarction. On admission, a nasopharyngeal swab was performed to assess the presence of SARS-CoV-2, as per hospital protocol during the current COVID-19 pandemic. A total-body CT angiography was performed to investigate the cause of acute limb ischaemia and to rule out aortic dissection; the examination showed a total occlusion of the left common iliac artery and a non-obstructive thrombosis of a subsegmental pulmonary artery branch in the right basal lobe. Lung CT scan confirmed a typical pattern of interstitial COVID-19 pneumonia. Coronary angiography showed a thrombotic occlusion of the proximal segment of the right coronary artery. Percutaneous coronary intervention was performed, with manual thrombectomy, followed by deployment of two stents. The patient was subsequently transferred to the operating room, where a Fogarty thrombectomy was performed. The patient was then admitted to the COVID area of our hospital. Seven hours later, the swab returned positive for COVID-19. Discussion COVID-19 can have an atypical presentation with thrombosis at multiple sites.

Delayed Presentation of Gluteal Compartment Syndrome due to Pseudoaneurysm Rupture

2019 ◽  
Vol 9 (3) ◽  
pp. e0346-e0346
Author(s):  
Matthew J. Braswell ◽  
Ashley Anderson ◽  
Michael Donohue ◽  
Michelle C. DiVito ◽  
Paul W. White ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Delayed Presentation ◽  
Gluteal Compartment Syndrome

Bilateral Gluteal Compartment Syndrome: A Rare but Potentially Morbid Entity

2010 ◽  
Vol 76 (7) ◽  
pp. 752-754 ◽  
Author(s):  
Jose Castro-Garcia ◽  
Brian R. Davis ◽  
Miguel A. Pirela-Cruz
Keyword(s):  
Compartment Syndrome ◽  
Operating Room ◽  
Illicit Drug ◽  
Early Recognition ◽  
Lumbar Pain ◽  
Interstitial Pressure ◽  
Sensory Deficits ◽  
Illicit Drug Abuse ◽  
The Right ◽  
Gluteal Compartment Syndrome

Compartment syndrome is caused by elevated interstitial pressure within the myofascial compartment. It rarely presents bilaterally in the gluteal region. A 49-year-old man fell 10 feet from a roof on his buttocks. He presented 10 hours after the injury with intense lumbar pain. Both glutei were exceptionally tense. There were no vascular injuries or sensory deficits. Compartmental pressures measured 60 mm Hg on the left side and 50 mm Hg on the right side. The patient was taken to the operating room for decompressive fasciotomy. The glutei compartments were released. He was taken once more to the operating room, requiring only minimal debridement. He was discharged the next week with no neurological deficit. Bilateral gluteal compartment syndrome is very rare with few cases reported in the literature. It has been associated with trauma, prolonged recumbence, surgical instrumentation, and illicit drug abuse. Early recognition is required to avoid the potential severe metabolic and physical deficits.

scholarly journals A novel role for milrinone in neonatal acute limb ischaemia: successful conservative treatment of thrombotic arterial occlusion without thrombolysis

2019 ◽  
Vol 12 (12) ◽  
pp. e232440
Author(s):  
Stephanie Boyd ◽  
Vibhuti Shah ◽  
Jaques Belik
Keyword(s):  
Treatment Options ◽  
Arterial Occlusion ◽  
Term Infant ◽  
Pulmonary Vasculature ◽  
Limb Ischaemia ◽  
Ischaemia Reperfusion Injury ◽  
Phosphodiesterase 3 ◽  
Acute Limb Ischaemia ◽  
Risk Treatment ◽  
The Right

Acute neonatal limb ischaemia (NLI) is most frequently an iatrogenic complication, however, may also occur in utero due to thromboembolism. There is no widely accepted protocol for treatment of NLI and limited evidence to guide management. Thrombolysis and surgical management have been attempted, though both are associated with significant morbidities. Milrinone is a phosphodiesterase-3 inhibitor used for its vasodilatory effects on the systemic and pulmonary vasculature. There is also emerging evidence for benefit of milrinone in ameliorating ischaemia-reperfusion injury. The authors present a case report of a term infant with spontaneous perinatal acute limb ischaemia secondary to near-completely occlusive thrombosis of the right subclavian artery. The infant was successfully managed conservatively with milrinone without requirement for thrombolysis or surgical intervention. Milrinone represents a novel treatment option for neonates with acute limb ischaemia and consideration of a trial of milrinone prior to higher risk treatment options is warranted in this patient group.

Gluteal Compartment Syndrome Following Abdominal Aortic Aneurysm Treatment

2016 ◽  
Vol 15 (4) ◽  
pp. 354-359 ◽  
Author(s):  
Emanuela Viviani ◽  
Anna Maria Giribono ◽  
Donatella Narese ◽  
Doriana Ferrara ◽  
Giuseppe Servillo ◽  
...  
Keyword(s):  
Compartment Syndrome ◽  
Postoperative Period ◽  
Lower Limb ◽  
Acute Ischemia ◽  
Aorta Aneurysm ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
Kissing Stent ◽  
The Right ◽  
Gluteal Compartment Syndrome

Compartment syndrome (CS) is a pathological increase of the interstitial pressure within the closed osseous fascial compartments. Trauma is the most common cause, followed by embolization, burns, and iatrogenic injuries; it usually involves the limbs. The major issue when dealing with CS is the possibility to do an early diagnosis in order to intervene precociously, through a fasciotomy, reducing the risk of tissue, vascular and nervous damage. Although it is an infrequent condition, it is potentially life threatening. In our case report, we present a 59-year-old patient, smoker, affected by hypertension, dyslipidemia, chronic renal failure, and morbid obesity who came at our attention for a 6-cm abdominal aorta aneurysm, treated with an aorto-aortic graft. Within 24 hours from surgery, the patient presented acute ischemia of the right lower limb due to thrombosis of the common iliac artery and underwent the positioning of a kissing stent at the aortic bifurcation. In the immediate postoperative period, a relevant increase in serum creatinine, creatine phosphokinase, and myoglobin value was recorded, associated with clinical presentation of swelling in the right buttock with intense pain. The diagnosis of gluteal CS was confirmed by the measurement of the gluteal compartment pressure, which resulted of 110 mm Hg. The treatment of the CS consisted in gluteal dermofasciotomy, surgical debridement of the buttock, and positioning of negative pressure medication, associated with infusive therapy, avoiding hemodialysis. Because of the epidural anesthesia only later on it was possible to observe a persistent plegia of the right lower limb, which was solved within 1 month of neurological and physical therapy. With our experience, we can state that the CS is an extremely severe complication that can occur in vascular surgeries and it should therefore be kept in mind in the short-term postoperative period in order to guarantee a precocious diagnosis and immediate treatment.

Thromboelastography utilization for dabigatran reversal in a patient with acute kidney injury

2021 ◽  
Author(s):  
Brian W Gilbert ◽  
M Jacob Ott ◽  
George J Philip
Keyword(s):  
Acute Kidney Injury ◽  
Lower Extremity ◽  
Compartment Syndrome ◽  
Kidney Injury ◽  
Clotting Factor ◽  
Surgical Interventions ◽  
Major Bleed ◽  
Active Extravasation ◽  
Complete Reversal ◽  
The Right

Abstract Purpose This case report describes utilization of thromboelastography (TEG) in the setting of an acute major bleed in a patient on dabigatran who had concomitant acute kidney injury. Summary An 80-year-old female presented to the emergency department after a fall with complaints of pain in her knee, shoulder, and hip. Her medical history was significant for coronary artery disease, for which she took clopidogrel 75 mg daily, and atrial fibrillation, for which she took dabigatran 150 mg twice daily. The physical exam was remarkable for pain within the shoulder, hip, and knee, which had swelling and ecchymosis that extended into the right thigh. Given the possibility of compartment syndrome with multiple possible etiologies of coagulopathy, TEG and computed tomography angiography (CTa) of the right lower extremity were performed. The initial TEG showed prolonged R time and activated clotting time, indicating clotting factor dysfunction with no additional coagulopathy noted, including antiplatelet effects. On the basis of the TEG and CTa findings, it was decided to reverse dabigatran with 5 grams of idarucizumab. Approximately 1 hour after administration of idarucizumab, the patient was taken to interventional radiology where a limited angiogram of the right lower extremity showed no active extravasation. Because of the patient’s renal dysfunction and the possibility of rebound hypercoaguability, repeat TEG tests were ordered at 4 and 8 hours after the initial reversal to ensure clearance of idarucizumab-dabigatran complexes. The repeat TEG values showed complete reversal of the initial coagulopathy noted. During the admission, the patient required no blood transfusions or surgical interventions and all her initial laboratory results improved. Conclusion Serial TEG testing was successful at managing multiple coagulopathies in a patient at risk for trauma-induced compartment syndrome.

scholarly journals Delayed Presentation of Acute Gluteal Compartment Syndrome

2016 ◽  
Vol 17 ◽  
pp. 503-506 ◽  
Author(s):  
James J. Tasch ◽  
Emmanuel O. Misodi
Keyword(s):  
Compartment Syndrome ◽  
Delayed Presentation ◽  
Gluteal Compartment Syndrome

P1123HEMOPERFUSION COMBINED WITH CRRT IN SEPTIC SHOCK AKI PATIENTS CAUSED BY OSTEOFASCIAL COMPARTMENT SYNDROME

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Xiaohua Sheng ◽  
Niansong Wang ◽  
Weifeng Huang ◽  
Gang Yu ◽  
Hongda Bao ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Compartment Syndrome ◽  
Blood Circulation ◽  
Kidney Injury ◽  
Lower Leg ◽  
Multiple Organ ◽  
History Of ◽  
The Right

Abstract Background and Aims Although Osteofascial compartment syndrome is rare, it can cause severe complications, including septic shock and acute kidney injury. Most commonly found on the palmar side of the forearm and lower leg. This article reported two cases of septic shock with acute kidney injury caused by osteofascial compartment syndrome, and explored the application of hemoperfusion combined with continuous renal replacement therapy in these two severe patients. Method Two young men, patient A was 38 years old and patient B was 44 years old. Hospitalized in June 2016 and February 2018, respectively. Previous healthy, after questioning, patient A had a history of type 1 diabetes and patient B had a history of gout. Patient A had a history of being beaten by his wife, patient B has no clear history of injury. Patient A showed swelling and pain in the right forearm and patient B showed swelling and pain in the right lower leg. After admission, they quickly developed shock, oliguria, acute kidney injury, multiple organ dysfunction. They were received fluid resuscitation, vasopressors, anti-infectives, respiratory support, nutritional support, and vital signs monitoring. Blood culture of patient A showed a case of group A hemolytic streptococcus, patient B showed streptococcus pyogenes and staphylococcus hemolytic. Patient A was performed CRRT for 3 days, combined with two hours hemoperfusion (HA-330, Jafron, Zhuhai City, China) on the first day of CRRT, once every 24 hours for two days. Patient B was performed CRRT for 16 days. combined with two hours hemoperfusion (HA-330, Jafron, Zhuhai City, China) on the first day of CRRT, once every 24 hours for two days. Both patients underwent multiple orthopaedic surgeries. Patient A underwent right upper limb amputation and patient B underwent right thigh amputation. Results After hemoperfusion, the amount of norepinephrine was significantly reduced, and the circulation became stable. Finally, two patients improved and were discharged from the hospital, and their renal function returned to normal. Conclusion Once the osteofascial compartment syndrome is diagnosed, the fascia should be decompressed immediately. After local incision and decompression, blood circulation is improved, and a large number of toxins from necrotic tissue enter the blood circulation, which can lead to serious complications such as sepsis, shock, acute kidney injury, and multiple organ failure. Renal replacement therapy and amputation surgery may save lives. Hemoperfusion can reduce the amount of norepinephrine, improve circulation and win surgical opportunities.

scholarly journals Gluteal Compartment Syndrome and Rhabdomyolysis after Prolonged Laparoscopic Nephroureterectomy and Treatment Strategies Including Rehabilitation: A Case Report

Healthcare ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 47
Author(s):  
Jae-Gyeong Jeong ◽  
Seock Hwan Choi ◽  
Ae-Ryoung Kim ◽  
Jong-Moon Hwang
Keyword(s):  
Blood Sample ◽  
Compartment Syndrome ◽  
Treatment Strategies ◽  
Chronic Phase ◽  
Operation Time ◽  
Patient Specific ◽  
Normal Ranges ◽  
Muscular Injury ◽  
The Right ◽  
Gluteal Compartment Syndrome

Background: Rhabdomyolysis is a clinical symptom caused by the rapid release of intracellular components such as myoglobin, lactate dehydrogenase, and creatine kinase into the blood circulation. It is commonly caused by muscular injury including compartment syndrome, infection, drugs, etc. Although it rarely occurs during surgery, the incidence may increase if risk factors such as long operation time, improper posture, and condition of being overweight exist. Case Presentation: A 46-year-old male patient complained of pain and weakness in the right hip area and several abnormal findings were observed in the blood sample, reflecting muscle injury and decreased renal function after prolonged urological surgery. He was confirmed as having rhabdomyolysis, which was caused by compartment syndrome of the right gluteal muscle. After the diagnosis, conservative cares were performed in the acute phase and rehabilitation treatments were performed in the chronic phase. After conservative treatment and rehabilitation, blood sample values returned to almost normal ranges and both level of pain and muscle strength were significantly improved. In addition, about 25 days after discharge, he almost recovered to pre-operative condition. Conclusion: Careful attention is required to prevent intraoperative compartment syndrome. It also suggests that not only medical treatment but also early patient-specific rehabilitation is important in patients with rhabdomyolysis after prolonged surgery.

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