title: The dangers of lithotomy positioning in the operating room: case report of bilateral lower extremity compartment syndrome after a 90-minutes surgical procedure.
abstract: BACKGROUND
  Lower extremity acute compartment syndrome after gynecologic surgery in the lithotomy position is a rare, yet potentially devastating complication. A high level of suspicion is paramount for early recognition and mitigation of acute compartment syndrome originating from prolonged surgery in lithotomy position.
  
  
  METHODS
  A 23-year-old female, gravida 1, para 0, underwent a laparoscopic salpingectomy for a ruptured ectopic pregnancy. Surgical time was 90 min. Postoperatively, the patient developed acute compartment syndrome of both legs necessitating emergent bilateral four-compartment fasciotomies, with repeated returns to the operating room for 2nd look procedures and delayed wound closures. The patient regained full function within 3 months and returned to an unrestricted baseline activity level.
  
  
  CONCLUSIONS
  Technical diligence in applying a lithotomy position is paramount for preventing postoperative lower extremity compartment syndrome. A high level of suspicion for this severe complication in conjunction with early recognition and immediate surgical management can mitigate long-term adverse sequelae and improve postoperative outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204 USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Stornelli
authors.affiliation: Department of Orthopaedic Surgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204 USA.
authors.forename: Frank B
authors.initials: FB
authors.lastname: Wydra
authors.affiliation: Department of Orthopaedic Surgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204 USA.
authors.forename: Justin J
authors.initials: JJ
authors.lastname: Mitchell
authors.affiliation: Department of Orthopaedic Surgery, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204 USA.
authors.forename: Philip F
authors.initials: PF
authors.lastname: Stahel
authors.affiliation: Department of Obstetrics and Gynecology, Denver Health Medical Center and University of Colorado School of Medicine, Denver, CO 80204 USA.
authors.forename: Stefka
authors.initials: S
authors.lastname: Fabbri
keywords: Adverse event; Compartment syndrome; Fasciotomy; Lithotomy position; Patient safety; Surgical complication