Gluteal compartment syndrome following alcohol intoxication: Case report and literature review

Abstract

Introduction A compartment syndrome (CS) occurs when increased pressure within an anatomic compartment leads to inadequate perfusion. Although rare, gluteal CS can be encountered when an unconscious person has a prolonged period of immobilization. Presentation of case A 20-year-old male with history of polysubstance abuse leading to passing out, presented with right buttock and lower extremity pain, increased creatinine phosphokinase (CPK), and acute renal failure. Physical examination and MRI confirmation supported gluteal CS. Patient was taken to the OR for gluteal fasciotomy. Afterwards, the pain improved, the CPK and creatinine trended to normal. He was discharged home on day 7. Discussion CS can occur in any part of the body with fascial compartments. Increased compartmental pressure causes compression of vessels and nerves in the area that can lead to ischemia and necrosis. CS can occur after trauma, excessive fluid resuscitation, or surgery. It is also reported due to the prolonged periods of immobilization and increasing pressure on dependent areas. Often, intra-compartmental pressure is measured to confirm the diagnosis. The mainstay of treatment is fasciotomy. Conclusion Due to the rarity of gluteal compartment syndrome, the diagnosis is often delayed. If the affected area is ischemic for a significant amount of time, it can lead to sciatic nerve palsy, paresthesias, paralysis and muscle necrosis. Patients may experience irreversible damage after the syndrome and as such providers should be cognizant of this clinical entity to make an early diagnosis of gluteal compartment syndrome.

Combined Upper Extremity and Gluteal Compartment Syndrome Following Illicit Drug Abuse: A Retrospective Case Series

“…Optimal prognosis is associated with performing a fasciotomy within 6 hours of presentation. 4 A fasciotomy decreases the intra-compartmental pressure, allowing for proper perfusion of the patient’s tissues. It is important to release the fascia along the entirety of the compartment to prevent incomplete release and continued tissue damage.…”

“…Depressants, including alcohol and heroin, have been described in the literature in multiple case reports as direct causes of obtundation and immobility leading to compartment syndrome. [3][4][5][6][7] Other substances such as synthetic cannabinoids or K2 have been less frequently described as being associated with compartment syndrome. In one study from Turkey, Ergul et al describes six cases in which synthetic cannabinoids were directly linked to cases of renal failure, rhabdomyolysis and compartment syndrome.…”

“…2 In the United States, prolonged immobilization after alcohol or opioid abuse is a common etiology of compartment syndrome. [3][4][5][6][7] In our cases, we have found that other illicit substances such as benzodiazepines, amphetamines and synthetic cannabinoids, which are less commonly described with compartment syndrome can also cause this presentation.…”

A Pain in the Butt: A Case Series of Gluteal Compartment Syndrome

“…1 Any of the three gluteal compartments, the anterior tensor fascia lata compartment, the gluteus medius and minimus compartment, or the posterior gluteus maximus compartment, can be affected. 2 Approximately 50% of cases are due to prolonged immobilization secondary to surgery, or alcohol or substance use. 3 Benns et al showed that compartment syndrome in patients with opioid use disorder (OUD) was more likely to be gluteal (31.8%) when compared to other etiologies and led to prolonged hospital admissions.…”

Delayed Presentation of Foot Compartment Syndrome

“…Compartment syndrome is an acute surgical emergency, with one common etiology being prolonged immobilization secondary to overconsumption of opioids [1]. These patients provide a unique subset of management challenges.…”