Teaching Case: Acute, Exercise-Induced Compartment Syndrome, Rhabdomyolysis, and Renal Failure–A Case Report

ABSTRACT Introduction Compartment syndrome is defined as a symptom complex caused by increased pressure of tissue fluid in a closed osseofascial compartment which interferes with circulation to the myoneural components of the compartment. Bilateral compartment syndrome of the legs is a rare presentation requiring emergent surgical intervention. In a recent case report (Khan et al 2012) there have been only eight reported cases cited with bilateral compartment syndrome. Heroin abuse is known to cause compartment syndrome, traumatic and atraumatic rhabdomyolysis. Hypothyroidism can also independently present with rhabdomyolysis. Case presentation We present a case of a 22 years old female who presented with bilateral swelling of the legs with associated loss of sensation having spent two days kneeling against the wall following IV heroin abuse. She presented to the emergency department with bilateral swelling of the legs with loss of sensation. She was diagnosed with compartment syndrome requiring emergent bilateral 4 compartment fasciotomy of the lower extremities. Inspite of aggressive fluid resuscitation she developed rhabdomyolysis complicated by acute renal failure requiring dialysis. She made a full recovery with full return of her renal as well as motor and sensory function. Conclusion We discuss this interesting case of bilateral compartment syndrome in a heroin abusive patient with history of hypothyroidism complicated by rhabdomyolysis and acute renal failure. There have been isolated case reports of bilateral compartment syndrome following prolonged surgery. High index of suspicion, early recognition and therapeutic intervention is the key to good outcome. We discuss the etiopathology and management options of rhabdomyolysis. Treating the comorbities like hypothyroidism is also important for the recovery. How to cite this article Biswas S, Rao RS, Duckworth A, Kothuru R, Flores L, Abrol S. Bilateral Atraumatic Compartment Syndrome of the Legs Leading to Rhabdomyolysis and Acute Renal Failure Following Prolonged Kneeling in a Heroin Addict. A Case Report and Review of Relevant Literature. J Trauma Critical Care Emerg Surg 2013;2(3):139-145.

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Mechanisms of exercise-induced acute renal failure in idiopathic renal hypouricemia: a case report and a review of the literature

Nihon Shoni Jinzobyo Gakkai Zasshi ◽

10.3165/jjpn.22.147 ◽

2009 ◽

Vol 22 (2) ◽

pp. 147-151

Author(s):

Reiko Takewa ◽

Naho Taniguti ◽

Sachiyo Tanaka ◽

Takahide Nakano ◽

Masafumi Hasui ◽

...

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Case Report ◽

Review Of The Literature ◽

Renal Hypouricemia ◽

Idiopathic Renal Hypouricemia ◽

Exercise Induced

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Acute lumbar paraspinal compartment syndrome: a case report and detailed literature review

International Surgery Journal ◽

10.18203/2349-2902.isj20164699 ◽

2017 ◽

Vol 4 (2) ◽

pp. 775 ◽

Cited By ~ 2

Author(s):

Ahlam M. Alfaraj ◽

Zainab M. Alfaraj ◽

Abdullah G. Alsahwan

Keyword(s):

Renal Failure ◽

Low Back Pain ◽

Case Report ◽

Compartment Syndrome ◽

Clinical Characteristics ◽

Medical Literature ◽

Full Recovery ◽

Low Back ◽

Athletic Activity ◽

Direct Trauma

The 17th case of acute lumbar paraspinal compartment syndrome in the scientific/medical literature was presented in this study. We then review all 17 cases for demographic and clinical characteristics, in particular in terms of how they influence ultimate outcomes. All but one case occurred in a male, and most patients were less than age 40 (71%). Symptoms typically were precipitated by some athletic activity (59%), other causes were surgery (n = 4), drug abuse (n = 2), and direct trauma (n =1). Peak CPK values ranged from 5000 to 350,000 U/L. Ten patients ultimately achieved or were presumed to achieve full recovery, six had persistent low back pain several months later and one remained in renal failure. The only predictor of final outcome was the treatment given, with six of seven who underwent surgical fasciotomy and both patients administered hyperbaric oxygen experiencing full recovery, versus just two of seven treated conservatively (p = 0.03).

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