ESRA19-0176 Urological surgery and lower extremity compartment syndrome: report of two cases

Background and aimsLower extremity compartment syndrome (CS) is a complication related to prolonged laparoscopic pelvic surgery, especially in the Lithotomy-Trendelenburg position (LTT) with the use of leg cuffs. We present two cases of CS who needed urgent fasciotomy after an 8 hour surgery, the fi...

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Bibliographic Details
Published in:	Regional anesthesia and pain medicine Vol. 44; no. Suppl 1; pp. A141 - A142
Main Authors:	Ereño Orbea, I, Ortega Mera, U, San Juan Gonzalez, M, Torre Mollinedo, F, Quincoces, A Fernandez Fernandez de, Telletxea Benguria, S, Rodriguez Bellanco, J, Aizpea, AJ, Elisa, DC, Marta, EA, Sofia, IM, Saioa, RO, Silvia, GT, Iratxe, GM, Maria Pilar, RR, Beatriz, EI, Beatriz, DVV
Format:	Journal Article
Language:	English
Published:	Secaucus BMJ Publishing Group LTD 01-10-2019
Subjects:	Compartment syndrome Surgery Urological surgery
Online Access:	Get full text
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Summary:	Background and aimsLower extremity compartment syndrome (CS) is a complication related to prolonged laparoscopic pelvic surgery, especially in the Lithotomy-Trendelenburg position (LTT) with the use of leg cuffs. We present two cases of CS who needed urgent fasciotomy after an 8 hour surgery, the first patient after a radical prostatectomy and the second after a radical cystectomy.MethodsCS occurs when perfusion to an extremity is inadequate because of either decreased arterial flow or venous outflow from LTT and pneumoperitoneum. Once reversed, results in tissue edema. We report two patients of middle age diagnosed with CS. The first patient had a history of obesity and SAOHS; the second one, chronic venous insufficiency. Both cases were treated by urgent surgical decompression under spinal anesthesia. The first one, after 48 hours, multiple surgical procedures were necessary for function recovery at one year. The second patient underwent surgery during the first 6 hours. After 5 months he walked without help.ResultsWe report two cases of CS in the postoperative period, focusing on the importance of an immediate surgical treatment. So far no evidence-based recommendation for prevention exists. The knowledge of this syndrome associated with prolonged LTT is essential to suspect it, contributing individual risk factors. Differential diagnosis should be made with deep venous thrombosis; intra-compartmental pressure measurement should never delay surgery with clinical suspicion.ConclusionsLower extremity CS is a rare but devastating complication. A delay in diagnosis and treatment can be life-threatening. All medical personal involved should be aware after a long-lasting operation in the LTT position.
ISSN:	1098-7339 1532-8651
DOI:	10.1136/rapm-2019-ESRAABS2019.198