Spontaneous Four Limb Compartment Syndrome

Abstract

SummaryWe present a unique case of atraumatic rhabdomyolysis and four-limb compartment syndrome. Edema and inflammation associated with rhabdomyolysis, was further exacerbated by aggressive saline resuscitation. This resulted in raised compartment pressures and necessitated four-limb fasciotomy. The cause of rhabdomyolysis was most likely multifactorial including systemic capillary leak syndrome seizure, illicit drug use (crack cocaine and methamphetamine) and the prescription medication, mirtazapine. RésuméNous présentons ici un cas exceptionnel de rhabdomyolyse atraumatique accompagnée d'un syndrome des loges aux quatre membres. L'oedème et l'inflammation associés à la rhabdomyolyse ayant été exacerbés par une réanimation liquidienne agressive, il en est résulté une augmentation de la pression dans les loges et il a fallu procéder à une aponévrotomie aux quatre membres. La rhabdomyolyse a été très probablement causée par plusieurs facteurs, dont une crise systémique d'un syndrome de fuite capillaire et l'usage illicite de drogues (cocaïne épurée ou crack, méthamphétamine) jumelé au médicament prescrit, la mirtazapine.

Spontaneous compartment syndrome of all limbs: A case report

“…Riolo et al in 2015 have reported a case of four-limb compartment syndrome in 49-year-old with a history of hepatitis B, chronic hepatitis C, and epilepsy; the patient developed four-limb compartment syndrome, and they concluded that it was due to rhabdomyolysis caused by multiple factors, the patient underwent urgent four-limb fasciotomy. [7] Also, Khan et al had reported a similar case (only in one limb) of 41-year-old medically free lady who suffered from rhabdomyolysis and acute renal failure simultaneously, and the cause was attributed to inadvertent posturing while sleeping. [8] The patient developed bilateral spontaneous compartment syndrome in the leg, which was treated by fasciotomy.…”

“…Furthermore, this, in turn, may lead to a closed cycle of increasing edema, and more muscle damage and necrosis. [7] Dalton et al described a case of acute spontaneous compartment syndrome in both forearms in a 31-year-old lady with no history of trauma presented to the ED with acute compartment syndrome in the forearm. Her past medical history was only positive for hypertension and coeliac disease.…”

“…Sofat et al [13] Alcohol intoxication (bilateral legs) Bilateral fasciotomies Lynch et al [14] Exercise-induced (bilateral legs) Bilateral fasciotomies Ramdass et al [15] Simvastatin, thyroxine induced (bilateral legs) Bilateral fasciotomies Lu et al [16] Vibrio vulnificus infection (bilateral legs) Bilateral fasciotomies Figueras Coll et al [17] Methanol poisoning (bilateral legs) Bilateral fasciotomies Naidu et al [18] Horse riding (bilateral legs) Bilateral fasciotomies Ballesteros et al [19] Prolonged kneeling position during spinal surgery (bilateral legs) Bilateral fasciotomies Chin et al [20] Prolonged lithotomy position (bilateral legs) Bilateral fasciotomies Simon et al [21] Four-limb compartment syndrome associated with the systemic capillary leak syndrome Four-limb fasciotomy Khan et al [8] Inadvertent posture during sleep (bilateral legs) Bilateral fasciotomies Osteen et al [11] Prolonged intraoperative position and simvastatin use (bilateral glutei) Bilateral fasciotomies Davidson et al . [10] Antiretroviral myositis (bilateral legs) Bilateral fasciotomies Dalton et al [9] Hypertension and telmisartan use (bilateral forearms) Bilateral fasciotomies Riolo et al (2015) [7] Spontaneous four limb compartment syndrome Four-limb fasciotomy Current case Spontaneous compartment syndrome of all limbs Four-limb fasciotomy…”

“…These conditions included diabetes mellitus, the use of anticoagulants, hypothyroidism, leukemic infiltrations, and nephrotic syndrome. [2,5,7] These chronic conditions can cause edema and swelling in a given compartment, leading to compartment syndrome development. [3] There are some theories in multiple case reports correlating compartment syndrome with the use of medications such as non steroidal anti-inflammatory drugs (NSAIDs) (Diclofenac).…”

Impending Compartment Syndrome Secondary to Pseudoaneurysm following Stabilization of Proximal Tibia Shaft Fracture: A Case Report

“…Compartment syndrome is a surgical emergency with multiple traumatic and nontraumatic causes [1]. There have been reports of uncommon multiple conditions leading to acute compartment syndrome outside the scope of trauma such as diabetes mellitus, hypothyroidism, leukemia infiltration, nephrotic syndrome, rhabdomyolysis, and the use of anticoagulation [2][3][4][5]. The relation between tibia shaft fracture and compartment syndrome has been well established in the literature, and the gold standard treatment of such a fracture is intramedullary nail fixation with surgical decompression of the leg compartments [6,7].…”