Compartment syndrome of the leg in the coagulopathic, end-stage liver disease patient: Fasciotomy is not the best answer.
BACKGROUND
Compartment syndrome of the leg secondary to spontaneous bleeding has been described in coagulopathic patients. Correction of the coagulopathy and emergency fasciotomy is the recommended treatment. We present a cirrhotic patient with a short life expectancy who developed compartment syndrome of the leg secondary to spontaneous bleeding. This patient underwent fasciotomy of the leg and subsequently developed persistent postoperative bleeding and required repeated transfusions of blood and blood products. The patient eventually expired in the hospital 1 month after surgery.


RESULTS
Compartment syndrome of the leg occurring in patients with coagulopathy secondary to cirrhosis is very difficult to manage. Coagulopathy in these patients is hard to correct and constant bleeding from fasciotomy site is a major complication mandating frequent transfusions of blood and blood products. The complications of fasciotomy in these patients may outweigh the complications of untreated fasciotomy, particularly in patients with a short life expectancy.


CONCLUSIONS
Fasciotomy is not always the best treatment for compartment syndrome of the leg. In certain patients, particularly in the coagulopathic, end-stage cirrhotic patient with a short life expectancy who is not a candidate for liver transplantation, fasciotomy is not indicated. Fasciotomy should be used selectively, if at all, in patient population with end-stage and terminal diseases.
Milanchi
Siamak
S
Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Magner
David
D
D003161:Compartment Syndromes / Q000209:etiology / Q000601:surgery*; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D000071938:Fasciotomy; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007866:Leg; D008103:Liver Cirrhosis / Q000150:complications*; D008875:Middle Aged; D016896:Treatment Outcome