Lower limb compartment syndrome by reperfusion injury after treatment of arterial thrombosis post-laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer

Abstract

Compartment syndrome is a clinical condition associated with decreased blood circulation that can lead to swelling of tissue in limited space. Several factors including lithotomy position, prolonged surgery, intermittent pneumatic compressor, and reperfusion after treatment of arterial thrombosis may contribute to compartment syndrome. However, compartment syndrome rarely occurs after gynecologic surgery. In this case, the patient was diagnosed as compartment syndrome due to reperfusion injury after treatment of arterial thrombosis, which occurred after laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer. Despite its rarity, prevention and identifying the risk factors of complication should be performed perioperatively; furthermore, gynecologist should be aware of the possibility of complications.

Spontaneous compartment syndrome and endovascular repair of tibioperoneal trunk pseudoaneurysm in Ehlers-Danlos syndrome

“…Given the patient's multilevel disease and multiple dissections in the lower extremity vasculature, it is possible that there was temporary flow limitation, resulting in ischemia to the limb and severe pain. Subsequently, restoration of flow lead to a reperfusion syndrome (16,17) and ultimately compartment syndrome in our patient. Consideration was given to the treatment of the inflow at the left EIA dissection.…”

“…Subsequently, restoration of the flow led to reperfusion syndrome and, ultimately, compartment syndrome in our patient. 16 , 17 Consideration was given to the treatment of the inflow at the left EIA dissection. However, given the chronicity of this dissection flap and difficulty in stent sizing and deployment in the setting of common iliac artery and proximal EIA aneurysms ( Fig 2 ), intervention was not pursued.…”

Acute compartment syndrome

“…It was recommended as routine procedure along with vascular repair especially when popliteal arterial injury is associated with concomitant venous injury. [48] On the other hand, infection associated with open fasciotomy incisions has been concerned. Although the reperfusion in patients with vascular injury was existed, but with an intact structure, nerve and function may recover later with some extents.…”

Acute iliac arterial thrombosis during laparoscopic abdominoperineal resection

“…In our case, the thrombosis was presumed to associate with acute limb ischemia according to the past history and operative findings without traumatic procedure. No article elaborated the incidence of iliac arterial thrombosis during the surgery but, to the best of our knowledge, there are only eight cases reporting the intraoperative acute limb ischemia in terms of pelvic surgeries except this case (Table 1 ) [3–8]. Of note, this is the first case with acute limb ischemia during a laparoscopic gastroenterological surgery.…”