Missed positional gluteal compartment syndrome in an obese patient after foot surgery: a case report

Abstract

Background Gluteal compartment syndrome is an uncommon condition and can be difficult to diagnose. It has been diagnosed after trauma, vascular injury, infection, surgical positioning, and prolonged immobilization from drug or alcohol intoxication. The diagnosis is based on clinical findings and, in most cases, recognizing these symptoms and making a diagnosis early is critical to a complete recovery. Case presentation A 53-year-old male who underwent left foot surgery had severe pain to his contralateral hip and posterior gluteal compartment radiating to the right lower extremity immediately postoperative. He was positioned supine with a “bump” placed under his right hip to externally rotate his operative leg during the surgery. Due to the patient’s complex past medical history, a presumptive diagnosis of a herniated disc and/or compression of the sciatic nerve was made as a cause for the patient’s pain. This resulted in a misdiagnosis period of 36 h until the patient was diagnosed with unilateral gluteal compartment syndrome. Performing a fasciotomy was decided against due to the increased risk of complications. The patient was treated with administration of IV fluids and closely monitored. On post-op day 6, the patient was discharged. At three months post-op, the patient was walking without a limp and he had no changes in his peripheral neurologic examination compared to his preoperative baseline. Conclusion Gluteal compartment syndrome is a surgical emergency that must be considered postoperatively especially in obese patients with prolonged operation times who experience acute buttock pain. The use of positional bars or “bumps” in the gluteal area should be used with caution and raise awareness of this complication after orthopedic surgeries.

Acute compartment syndrome after a lapidus-akin procedure: A case report

“…ACS associated with elective surgery is well documented. Khalifa et al (6) documented ACS of the gluteal compartments after reconstructive foot surgery. The authors attributed use of a hip bump as well as operating time (3hours and 53 minutes) as possible contributing factors.…”

Concomitant Gluteal and Thigh Compartment Syndrome Following Atraumatic Injury

“…The gluteal region is a rare anatomic location for compartment syndrome. However, the majority of the reported cases of gluteal compartment syndrome were a direct result of prolonged immobilization [1][2][3][4][5]. The gluteal region has been documented to form three separate compartments in cadaveric studies.…”

“…The most commonly reported causes of prolonged immobilization leading to gluteal compartment syndrome in the literature include heavy substance use and surgical positioning [2][3][4][5][6][7]. Traumatic injuries, typically resulting from a crush injury to the lower lumbar spine, pelvis, and buttocks area, comprise approximately 20% of cases.…”

Gluteal compartment syndrome secondary to prolonged immobilization following carbon monoxide poisoning associated with leukoencephalopathy: A case report

“…Gluteal compartment syndrome (GCS) is a rare diagnosis and results mostly from a non-traumatic case such as prolonged surgery, substance abuse, or drug overdose [ [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] ]. Carbon monoxide poisoning as a cause of gluteal compartment syndrome is rarely reported in the literature [ 17 , 18 ].…”