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.

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.

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 Uterine Torsion Masquerading as Abruptio Placentae: Diagnosed on Laparotomy

2020 ◽  
Author(s):  
Niranjan Mayadeo ◽  
Anusha Devalla
Keyword(s):  
Caesarean Section ◽  
Acute Abdomen ◽  
Postoperative Period ◽  
Clinical Presentation ◽  
Diagnostic Dilemma ◽  
Abruptio Placentae ◽  
Obstetric Emergency ◽  
Uterine Torsion ◽  
Life Threatening ◽  
The Right

Uterine torsion is a rare, life-threatening and unexpected obstetric emergency. It is almost always diagnosed at caesarean section. Its ill-defined clinical presentation may pose a diagnostic dilemma. Here the authors present a case of 32-year-old, Primigravida, 36 weeks pregnancy with acute abdomen and intrauterine foetal demise. Clinical features resembled Abruptio Placentae. The diagnosis of uterine torsion (180°) was established on laparotomy where the left ovarian ligament was seen on the right side anteriorly. A posterior hysterotomy was done to extract the baby which was followed by detorsion of the uterus. The postoperative period was uneventful.

scholarly journals Compartment Syndrome following Bothrops Snakebite Leads to Decompressive Fasciotomies

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Murilo Sérgio Valente-Aguiar ◽  
Bruno Gonçalves da Costa e Silva ◽  
Teresa Magalhães ◽  
Ricardo Jorge Dinis-Oliveira
Keyword(s):  
Compartment Syndrome ◽  
Lower Limb ◽  
Severe Pain ◽  
Clinical Course ◽  
Tropical Disease ◽  
Morbidity And Mortality ◽  
Neglected Tropical Disease ◽  
The Right

Snakebite envenoming is a neglected tropical disease with relevant morbidity and mortality. In this report, we illustrate the clinical course of a suspected Bothrops snakebite envenoming of a patient that evidenced severe pain, edema, pallor, regional lymphadenopathy, ecchymosis, myonecrosis, and bullous erythema in the right lower limb, specially around the fang marks. The clinical course progressed to compartment syndrome followed with decompressive fasciotomies to reduce pressure within the affected compartment.

scholarly journals Severe lower limb ischemia by massive arterial thrombosis revealing an acute myeloid leukemia needing for leg amputation: clinical and emotional aspects related to the communication with the patient and his family

2016 ◽  
Vol 8 (4) ◽  
Author(s):  
Paolo D'Angelo ◽  
Calogero Taormina ◽  
Clara Mosa ◽  
Floriana Di Marco ◽  
Fabrizio Valentino ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Lower Limb ◽  
Myeloid Leukemia ◽  
External Iliac Artery ◽  
Acute Ischemia ◽  
Thrombotic Complication ◽  
Emotional Aspects ◽  
The Right ◽  
Leg Amputation ◽  
Acute Myeloid

Large vessel thrombosis is a very rare clinical presentation of acute leukemia, generally associated with coagulopathy, usually characteristic of acute promyelocytic leukemia. A 13- year-old boy with a previously undiagnosed acute myeloid leukemia was referred to our hospital with acute ischemia of the right lower limb due to occlusion of the right external iliac artery, treated with emergency double surgical thromboembolectomy and chemotherapy. The thrombotic complication resulted in leg amputation. Now the boy is well in complete remission, with a good social integration and quality of life, 30 months after completing treatment. The report highlights the crucial role of early diagnosis and subsequent chemotherapy in avoiding amputation. We particularly focused critical and emotional aspects related to the communication about the leg amputation with the patient and his family.

Ischemia due to peripartum cardiomyopathy threatening loss of a leg

2003 ◽  
Vol 13 (2) ◽  
pp. 209-211 ◽  
Author(s):  
Paul J. Gagne ◽  
John B. Newman ◽  
Bart E. Muhs
Keyword(s):  
Vascular Complications ◽  
Peripartum Cardiomyopathy ◽  
Acute Ischemia ◽  
Initial Manifestation ◽  
Presenting Symptoms ◽  
Cardiac Condition ◽  
Life Threatening ◽  
Uncommon Condition ◽  
Arterial Insufficiency ◽  
The Right

Ischemia of the leg in a peripartum female is an uncommon condition. Paradoxical arterial embolisation, and arterial dissection, are rarely encountered but recognized causes of this clinical condition. Peripartum cardiomyopathy is a rare life-threatening cardiac condition that can foster intracardiac thrombosis and produce peripheral vascular complications through embolization. We present here the case of a young, healthy, postpartum female who developed acute ischemia of the left leg, and asymptomatic arterial insufficiency of the right lower leg, as the presenting symptoms of peripartum cardiomyopathy, highlighting the fact that ischemia threatening the loss of a limb can be the initial manifestation of peripartum cardiomyopathy.

scholarly journals Acute Digital Ischemia Associated with Closed Injury

2015 ◽  
Vol 116 (3) ◽  
pp. 239-243 ◽  
Author(s):  
David Janák ◽  
David Ručka ◽  
Jaroslav Kudlička ◽  
Vilém Rohn ◽  
Jaroslav Lindner ◽  
...  
Keyword(s):  
Lower Limb ◽  
Blunt Injury ◽  
Acute Ischemia ◽  
Blunt Injuries ◽  
Rare Phenomenon ◽  
Venous Injury ◽  
Digital Ischemia ◽  
The Right ◽  
Acral Ischemia ◽  
Worse Prognosis

Injury of an artery has a significantly worse prognosis for the patient than a venous injury. Blunt injuries of lower limb digital arteries with the development of acute ischemia present a very rare phenomenon. A crush mechanism with a defect of the non-wetted surface of vessel’s inner part and the development of subsequent thromboischemic lesion is essential for the development of ischemia. We report a blunt injury of the right lower limb in a patient after incorrect stepping with subsequent lesion of digital arteries and the development of acute acral ischemia of the right toes.

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