Chronic exertional compartment syndrome of the forearm: a case report

A 40-year-old man sustained a circumferential crush injury to his right forearm. Four months after injury, he experienced the onset of numbness and tingling in the distribution of the median nerve after exercise. Elevated compartment pressures of the palmar forearm and slowing of median nerve conduction after exercise suggested chronic exertional compartment syndrome. A flexor fasciotomy led to complete relief of symptoms, which allowed the patient unrestricted activity.     

Lumbar epidural abscess causing septic shock: case report

 This case report describes a lumbar epidural abscess that caused septic shock. A 48-year-old woman who developed a high temperature was diagnosed as having a respiratory tract infection. She became unconscious the next day and was transferred to the intensive care unit for monitoring and treatment. She complained of increasing lower back pain as consciousness improved. Magnetic resonance images of the lumbar spine showed an abscess shadow between the vertebral body and dura mater at the level of L3–S1. Surgical drainage of the epidural abscess was performed as an emergency procedure, and the patient recovered immediately. The primary source of the epidural abscess was probably the respiratory tract infection, which spread to the epidural space through hematogenous dissemination. The initial treatment of the epidural abscess was rest and antibiotics, but surgical treatment was needed to save the patient because of septic shock. Received: March 1, 2002 / Accepted: September 9, 2002 Offprint requests to: T. Yayama     

Chronic compartment syndrome of the flexor muscles in the forearm: a case report

A case is reported of a professional racing motor-cyclist who developed a chronic compartment syndrome of the flexor muscles in the forearm, confirmed by pressure measurements after exercise. Open fasciotomy of both the superficial and deep compartments cured the condition.     

Vibrio vulnificus necrotizing fasciitis presenting with compartmental syndrome of the hand

Vibrio vulnificus necrotizing fasciitis is an unusual clinical problem. When it presented as a compartment syndrome, the picture was obscured. We report a rare case of such a presentation. A below-elbow amputation was performed and the patient recovered.     

Necrotising fasciitis of the posterior neck crossing the midline: A case report

Introduction and importanceCraniofacial necrotising fasciitis is a complex condition, with high mortality given its propensity to descend via the deep neck spaces into the chest and mediastinum. Management requires optimal antimicrobial therapy with associated aggressive surgical debridement.Presentation of caseA 64-year-old man presented to ENT with a posterior neck swelling. Despite incision and drainage of the swelling following a trial of antimicrobial therapy, it increased in size, with areas of overlying necrosis demonstrated. Based on radiological and clinical findings, a diagnosis of necrotising fasciitis was made. He was taken to theatre for debridement. Intra-operatively, carotid sheath suppuration was noted, after tissue retraction resulted in copious bleeding from the anterior wound bed, requiring vigorous resuscitation and clamping of underlying structures to achieve haemostasis. Senior ENT and vascular surgery involvement was quickly sought to achieve haemostasis, however bleeding from the wound bed was difficult to control. This was due to the significant watershed area at the posterior neck which would not have been amenable to selective vessel ligation. After multiple cardiac arrests, a team decision was taken to discontinue resuscitation.Clinical discussionOperating in this area of anatomical complexity required input from a number of different specialty teams. Although input from infectious diseases, microbiology, plastic surgery and tissue viability was commendable, there was room for optimising this further. Early patient referral to a tertiary centre where on-site input was available from maxillofacial surgery and plastic surgery would have been beneficial; a set-up commonly seen in regional trauma networks.ConclusionThis case demonstrates the intricacies surrounding a rare occurrence of necrotising fasciitis of the neck crossing the midline. Multi-disciplinary team involvement is imperative and should be encouraged at an early stage.     

Acute compartment syndrome of the forearm in association with ulnar shortening osteotomy: a case report

A 41-year-old man experienced severe pain in the forearm after undergoing ulnar shortening osteotomy to treat positive ulnar variance, a complication of a fracture of the distal end of the radius. The patient had compartment syndrome with compartment pressure of 55 mm Hg. A decompressive fasciotomy of the volar compartment provided total relief of pain and, subsequently, full recovery of all functions. We report the case and discuss the serious nature of compartment syndrome, its associated complications, and methods of diagnosis and management.     

Necrotising fasciitis of the leg following a simple pelvic fracture: case report and literature review

Necrotising fasciitis is a rare complication following pelvic fracture, but has a high mortality rate. Topical negative pressure and maggot debridement therapy can be used alongside the usual treatment of surgical debridement and antibiotic therapy.     

Thoracic compartment syndrome: a case report

Thoracic compartment syndrome has been observed after trauma and after mediastinal and cardiac procedures; however, an adult respiratory distress syndrome (ARDS)-like presentation has not been described as a part of thoracic compartment syndrome. We describe the case of an obese patient who underwent coronary artery bypass (his third such procedure) and hiatal hernia reduction during the same operation, followed by transmyocardial laser revascularization and full chest closure the next day. The patient was hypoxic after chest closure. Two days later, his peak airway pressure increased, and his cardiac and urine outputs decreased. Chest radiography findings suggested ARDS without hemodynamic instability. After we reopened the sternal incisions, the patient's symptoms reversed. Although our patient initially appeared to have ARDS, we believe the organ-volume displacement that occurred during the lengthy dual operation produced a thoracic and abdominal compartment syndrome that responded to decompression of the chest.     

Compartment syndrome of the forearm as the initial symptom of systemic Vibrio vulnificus infection.

Sepsis, cellulitis, and necrotizing fasciitis rarely have been described as causes of compartment syndrome. We report a case in which forearm compartment syndrome presented as the initial symptom of systemic infection. Vibrio vulnificus, the etiologic pathogen of the compartment syndrome, was isolated from wound and blood cultures. The patient was treated with systemic antibiotic treatment and multiple forearm fasciotomies. The infectious process progressed rapidly, however and due to underlying liver insufficiency, the patient died of hepatorenal syndrome. This case illustrates the nature of V. vulnificus infections, which are characterized by shellfish transmission, predilection for soft tissue seeding, and a fulminant course in the compromised host.     

Isolated compartment syndrome of the pronator quadratus compartment: a case report

We present a case of compartment syndrome that involves the pronator quadratus space but does not affect any of the other forearm compartments. Symptoms consisted of pain out of proportion to examination findings, splinting of the forearm in a 30 degrees pronated position, and severe pain with passive supination. Diagnosis was confirmed with pressure measurements of all forearm compartments at the time of surgery. Symptoms resolved promptly with isolated release of the pronator quadratus compartment with concomitant reduction in compartment pressure in that one compartment.     

Necrotising fasciitis of the lower limb due to perforated inguinal hernia

Acute inguinal hernia complications (incarceration, strangulation) are relatively frequent conditions, especially in the elderly. Urgent surgery is the appropriate treatment if manual reduction is not achieved or strangulation or perforation is suspected. We present a 77-year-old patient with necrotising fasciitis of the lower limb as a consequence of extraperitoneal perforation of a sliding inguinal hernia. This devastating condition was diagnosed 20 h after the manual reduction of the hernia. Suspicion arose at the physical examination (crepitation, signs of cellulitis) and clinical deterioration of the patient, and was confirmed by computed tomography (CT) scanning. Urgent surgery was performed, including sigmoidectomy, debridement of the necrotic tissues of the medial and anterior thigh compartment, and fasciectomy, combined with optimal intensive care support. No signs of peritoneal or pelvic involvement were found. However, the comorbidities, advanced age and the progression of the disease led to fatal outcome. Early recognition of the complications of strangulated hernias is of vital importance for successful treatment in these cases, even if no signs of acute abdomen are present.     

Renal transplant compartment syndrome: a case report

An unusual case of early double kidney transplant dysfunction due to abdominal compartment syndrome is herein reported. A 62-year-old woman on peritoneal dialysis underwent dual kidney transplantation. The grafts were positioned extraperitoneally in both iliac possae using standard techniques. Surgical procedures and immediate postoperative period were uneventful. The urine output was immediate and the creatinine decreased, but in a few days she developed severe ascites with reduced urine output, increased creatinine, and progressive changes on Doppler ultrasound. The patient underwent paracentesis: the kidney function recovered as well as the Doppler ultrasound. Kidney biopsy was negative for rejection or renal pathology. Graft dysfunction was related to the presence of ascites. A catheter inserted in the abdomen measured intra-abdominal pressure (IAP) of 14 mm Hg. IAP correlated with renal function showing that IAP probably explained renal flow modifications.     

Anterior tibial compartment syndrome due to the pyomyositis in a patient with rheumatoid arthritis. A case report

Anterior tibial compartment syndrome was developed due to pyomyositis in a 33-year-old male patient with rheumatoid arthritis while receiving steroid therapy during the follow-up period. The preoperative physical examination, laboratory findings, MRI images, intraoperative observation and postoperative histopathological examinations confirmed the association with pyomyositis. The surgical drainage and antibiotic treatment were effective, and in the follow-up period, neuromuscular dysfunctions disappeared completely within 6 months. The patient has been asymptomatic for 4 years of follow-up. To date, anterior tibial compartment syndrome due to pyomyositis in a case with rheumatoid arthritis has not been reported.     

Septic shock due to pyonephrosis-calculosa: a case report]

A 69-year-old female was admitted to hospital with the complaint of high-grade fever and clouding of consciousness. Physical examination and laboratory data revealed septic shock, disseminated intravascular coagulation and multiple organ failure. Ultrasonography demonstrated left hydronephrosis and a cystic mass in peri-renal fatty tissue. KUB showed a left ureteral stone. A diagnosis of septic shock due to pyonephrosis-calculosa and peri-renal abscess was considered. A left nephrectomy, endotoxin removal therapy and continuous hemodiafiltration was performed. Thereafter all morbidities improved. A nephrectomy and intensive treatment are the good alternative method for such a case.