[Management of postoperative compartment syndrome -- case report].
OBJECTIVE
Differential diagnosis and management of the lower extremity compartment syndrome as a potentially devastating complication of prolonged surgery in the lithotomy position.


METHODS
A 55-year-old patient underwent radical cystoprostatovesiculourethrectomy including reconstruction of an ileal conduit because of a multifocal recurrent tumor of the urinary bladder (operating time > 8 hours). On the first postoperative day, the patient complained about swelling within the right calf leading to the suspicion of a deep vein thrombosis. Phlebography of the right leg revealed: i) thrombosis-untypical occlusion of the distal popliteal vein and ii) no detection of the deep vein within the right calf (femoral and iliac veins were with no pathological finding). Tissue pressure was as follows: right, 55 mmHg/left, 11 mmHg, underlining clinical suspicion of compartment syndrome. The patient underwent a fasciotomy of the right calf. Over the following 5 days, muscle edema decreased, allowing subsequent mobilization of the patient. On the 8 (th) postoperative day, the patient died unexpectedly due to an acute myocardial infarction.


CONCLUSIONS
In case of a swelling of the lower extremity after long-lasting surgical interventions performed in lithotomy position, a compartment syndrome is one of the possible differential diagnoses, the consequences of which can be avoided by an early diagnostic and adequate treatment.
Halloul
Z
Z
Klinik für Chirurgie, Universitätsklinikum, Medizinische Fakultät, Otto-von-Guericke-Universität, Magdeburg, Deutschland. Zuhir.Halloul@Medizin.Uni-Magdeburg.de
Tautenhahn
J
J
Meyer
F
F
Gebauer
T
T
Lippert
H
H
Bürger
T
T
D003161:Compartment Syndromes / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D003937:Diagnosis, Differential; D000071938:Fasciotomy; D005268:Femoral Vein; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010690:Phlebography; D011183:Postoperative Complications; D011187:Posture; D013997:Time Factors; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery