Gluteal Compartment Syndrome following an Iliac Bone Marrow Aspiration

Abstract

The compartment syndrome is a condition characterized by a raised hydraulic pressure within a closed and non expandable anatomical space. It leads to a vascular insufficiency that becomes critical once the vascular flow cannot return the fluids back to the venous system. This causes a potential irreversible damage of the contents of the compartment, especially within the muscle tissues. Gluteal compartment syndrome (GCS) secondary to hematomas is seldom reported. Here we present a case of a 51-year-old patient with history of a non-Hodgkin lymphoma who underwent a bone marrow aspiration from the posterior iliac crest that had excessive bleeding at the puncture zone. The patient complained of increasing pain, tenderness, and buttock swelling. Intraoperative pressure validation of the gluteal compartment was performed, and a GCS was diagnosed. The patient was treated with a gluteal region fasciotomy. The patient recovered from pain and swelling and was discharged shortly after from the hospital. We believe clotting and hematologic disorders are a primary risk factor in patients who require bone marrow aspirations or biopsies. It is important to improve awareness of GCS in order to achieve early diagnosis, avoid complications, and have a better prognosis.

Unusual Presentation of Compartment Syndrome

“…Gluteal compartment syndrome has been reported as a complication after bone marrow biopsy from iliac crest to a patient who was anticoagulated [71]. The same complication was reported after posterior iliac crest marrow biopsy of a patient suffering from non-Hodgkin lymphoma; however, on this case, platelet number and clotting times were normal [72].…”

Bone marrow aspiration complications: Iliopsoas abscess and sacroiliac osteomyelitis

“…Myeloproliferative disorders, treatment with aspirin or warfarin, obesity and disseminated intravascular coagulation are some risk factors leading to complications. In literature some complications such as prolonged pain, loss of function, bleeding, hematoma, needle breakage, bone fracture, compartment syndrome and infections were reported after bone marrow aspiration and biopsy [8][9][10][11][12] . Bleeding has been reported as the most common complication 12 .…”

25 Years Old Women With Inflammatory Low Back Pain

“…It is remarkable that despite the pain and missing focal lesions it has been reported that marrow biopsy causes hemorrhagic or compartmental complications during iliac crest bone biopsy procedures ( 29 ).…”