[Compartment syndrome or gas gangrene? A case report].
A case of forearm compartment syndrome due to a minor trauma is reported. The severe clinical conditions due to a shock state lead to an initial misdiagnosis of clostridial myonecrosis. The patient, 68 y-old woman, was admitted to the intensive care unit of Authors' hospital for a traumatic injury of the right forearm. A diagnosis of gas gangrene due to clostridial myonecrosis was done and forearm amputation suggested. In spite of this indication a decompression fasciotomy of the forearm compartments was performed as well as a hyperbaric oxygene therapy. Since culture of necrotic tissue samples did not demonstrate any bacterial growth, the Authors decided to avoid amputation and perform a radial arteriovenous fistula to improve venous return and reduce distal edema and continuous bleeding, with a complete recovery within 40 days. Good evaluation of patient with suspected compartment syndrome means correct and not delayed treatment, avoiding invalidating outcome.
Assenza
M
M
Dipartimento di Chirurgia Pietro Valdoni, Università degli Studi La Sapienza, Roma.
Borromeo
C
C
Moschella
C M
CM
Romagnoli
F
F
Clementi
I
I
Portieri
M
M
Tomei
B
B
Rengo
M
M
D000368:Aged; D001134:Arm Injuries / Q000150:complications; D001166:Arteriovenous Shunt, Surgical; D003161:Compartment Syndromes / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D003937:Diagnosis, Differential; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm; D005738:Gas Gangrene / Q000175:diagnosis*; D006801:Humans; D006931:Hyperbaric Oxygenation; D007362:Intensive Care Units; D013997:Time Factors