Compartment syndrome in all four extremities: a rare case associated with systemic capillary leak syndrome

While isolated limb injuries often lead to suspicion for and treatment of compartment syndrome, multi-limb compartment syndrome induced by a systemic disease is a rare entity, in which lack of immediate diagnosis can have catastrophic consequences to the patient. We present a patient with idiopathic systemic capillary leak syndrome (SCLS) resulting in compartment syndrome in all four extremities. Treatment required bilateral hand, forearm, calf, and thigh fasciotomies. Presenting symptoms included pain in all four extremities, malaise, and confusion. Laboratory data included polycythemia, hypoalbuminemia, leukocytosis, and elevated creatinine, but not a monoclonal spike on serum electrophoresis as is common in SCLS. Thus, when faced with clinical evidence of multiple extremity compartment syndrome, the surgeon should consider systemic disorders, such as SCLS, and aggressively treat the compartment syndrome as well as the underlying disease.     

Four-limb compartment syndrome associated with the systemic capillary leak syndrome

Systemic capillary leak syndrome, or the Clarkson syndrome, is an extremely rare condition in which increased capillary permeability results in a massive shift of fluid into the extravascular space. This is followed rapidly by hypotensive shock, haemoconcentration, and, potentially, substantial oedema of the limbs resulting in an acute compartment syndrome. It is important for orthopaedic surgeons to be aware of this syndrome as our medical colleagues, who initially care for these patients, are less familiar with the diagnosis and the need for emergency management of the associated compartment syndrome should it develop. There have been fewer than 100 cases of this entity reported. This case report is the first to describe the subsequent development of a compartment syndrome in all four limbs. Clinical vigilance and continuous monitoring of intracompartmental pressure is necessary in these patients in order to help reduce limb-threatening complications.     

Systemic capillary leak syndrome associated with compartment syndrome and rhabdomyolysis

Systemic capillary leak syndrome (SCLS) is a rare disorder characterized by recurrent spontaneous episodes of hypovolaemic shock due to marked plasma shifts from the intravascular to the extravascular space. This presents as the characteristic triad of hypotension, haemoconcentration and hypoalbuminemia often with an associated monoclonal gammopathy. We describe a patient with SCLS who required aggressive fluid resuscitation and emergency fasciotomies for compartment syndrome with rhabdomyolysis. At presentation the patient was considered to have severe erythrocytosis and was therefore initially referred to a haematologist, which appears to be a frequent sequence of presentation for patients with SCLS. This patient also highlights the importance of muscle compartment pressure monitoring during volume resuscitation in patients with SCLS.     

Systemisches Kapillarlecksyndrom als Ursache eines Kompartmentsyndroms beider Unterschenkel und eines Unterarms

Systemic capillary leak syndrome is a rare disorder which causes recurrent episodes of hypovolemic shock due to a markedly increased plasma shift into the interstitium. Hemoconcentration, hypoalbumimenia and a monoclonal gammopathy are characteristic laboratory findings. A rare manifestation of this disease is a compartment syndrome with rhabdomyolysis and acute renal failure. We describe a patient who suffers from a compartment syndrome of both lower legs and the left forearm secondary to systemic capillary leak syndrome, and discuss the pathophysiological background.     

Compartment syndrome: a review of the literature

Compartment syndrome is a rare but severe complication of lower extremity trauma. This article provides an extensive review of the literature, including incidence, physical examination findings, pathophysiology, compartment pressure evaluation, and surgical decompression techniques. Most of the recent compartment syndrome literature shows case reports of atypical causes of this limb-threatening disorder. Although the emphasis of this article is traumatic compartment syndrome, recent literature on chronic lower extremity compartment syndrome, secondary to exercise or activity, is also discussed.     

Compartment syndrome of the buttock following a total hip arthroplasty

An elevation of the interstitial pressure in a closed osseofascial compartment results in compartment syndrome. This may be caused by a decrease in compartment volume or an increase in compartment contents. The gluteal compartment syndrome is rare. Because the gluteal region has a large volume, this compartment requires a massive increase in content to cause a compartment syndrome. Also, this compartment blends anatomically with the muscles of the thigh, allowing extravasation of blood outside the compartmental envelope. This case report is of a patient whose medial circumflex femoral artery was severed during a total hip arthroplasty through a posterior approach leading to compartment syndrome of the buttock. Although this clinical presentation has not been described as compartment syndrome, one similar presentation was described in the literature.     

Bilateral medial foot compartment syndrome after an aerobics class: a case report

The authors present an unusual case of bilateral medial foot compartment syndrome in a healthy woman after a low-intensity aerobics exercise class. The majority of compartment syndrome cases have occurred after trauma, such as combat crush injuries and motor vehicle accidents. We wish to call attention to a rare situation in which compartment syndrome occurs in a healthy young adult after low-intensity exercise and highlight the necessity of a high clinical suspicion and a low threshold for fasciotomies to prevent irreversible muscle damage as a result of extremely high pressures. There is a paucity of cases on the clinical management and follow-up of this rare occurrence of compartment syndrome.     

Isolated medial foot compartment syndrome after ankle sprain

Foot compartment syndrome is a serious potential complication of foot crush injury, fractures, surgery, and vascular injury. An acute compartment syndrome isolated to the medial compartment of the foot after suffering an ankle sprain is a rare complication.We report the case of a 31-year-old man who developed a medial foot compartment syndrome after suffering a deltoid ligament rupture at ankle while playing football. The patient underwent a medial compartment fasciotomy with resolution of symptoms.Compartment syndromes of the foot are rare and have been reported to occur after severe trauma. But, there are some reports in the literature of acute exertional compartment syndrome. In our case, the compartment syndrome appeared after an ankle sprain without vascular injuries associated.     

Compartment syndrome and systemic hypertension

We present two rare variations related to compartment syndrome. The first is a 69-year-old hypertensive man with compartment syndrome of the arm. The second is a 58-year-old man with compartment syndrome of the forearm with severe compensatory hypertension.     

Recurrent compartment syndrome of foot following a calcaneal fracture

We report a rare case of a recurrent compartment syndrome following a fracture of the calcaneus in a patient who had undergone complete fasciotomies in the same foot 7 years ago. Compartment syndrome is a recognized complication following a calcaneal fracture, which if unrecognized, may result in significant contractures, claw toe deformity, sensory deficits, pain and stiffness of the foot. The complex anatomy of the foot can make the diagnosis of a compartment syndrome difficult and fasciotomy more exacting, particularly in a recurrent presentation. Timely recognition and urgent compartment fasciotomies led to a good clinical outcome in this case.     

Multiple compartment syndrome in a pediatric patient with CML

Compartment syndrome is a limb-threatening and life-threatening emergency resulting from elevated intracompartmental pressure. Prompt surgical intervention and treatment are necessary to prevent irreparable damage to muscle and nerve tissues. Leukemic infiltration of the muscle is an unusual cause of compartment syndrome and has been documented to occur secondary to hyperleukocytic leukemias, most commonly in acute myeloid leukemia. We present a rare case of multiple compartment syndrome in the buttock and thigh of an 11-year-old male patient with chronic myelomonocytic leukemia. The diagnosis of acute compartment syndrome was delayed, causing irreversible tissue damage. Physicians are generally unfamiliar with leukemia-induced complications and may not initially suspect leukemic compartment syndrome because of its rarity. Awareness of its clinical features is critical, because early diagnosis and prompt surgical debridement can prevent significant morbidity and even death.     

Compartment syndrome of the thigh in an infant: a case report

Compartment syndrome of the thigh in children is rare. We report a case of compartment syndrome of the thigh in an infant with a femur fracture resulting from suspected nonaccidental trauma. The delayed presentation of this injury may have been contributory to the development of compartment syndrome. The subtle physical findings in this case underscore the need for a high index of suspicion in making the diagnosis of compartment syndrome. The complete recovery of muscle function, even in the presence of significant tissue damage, is noteworthy and suggests that infants have a greater physiologic ability to recover in comparison with adults.     

Gluteal compartment syndrome following joint arthroplasty under epidural anaesthesia: a report of 4 cases

Compartment syndrome is characterised by an increase in the interstitial pressure within a closed osseofascial compartment. This may be due to a decrease in compartment volume, an increase in compartment content or external pressures. We report 4 patients who required surgical decompression for gluteal compartment syndrome that developed after joint arthroplasty. Gluteal compartment syndrome is rare, has high morbidity, and can be life threatening if not detected early. We emphasise the importance of identifying patients at risk, frequent monitoring of patients with continuous epidural infusions, reporting of motor blockade, and regular changing of the patient's position postoperatively.     

Recurrent compartment syndrome after open tibial fracture

Recurrence of compartment syndrome after surgical decompression is rare. We report a case where this occurred after open tibial fracture. A compartment syndrome is a clinical condition in which increased interstitial pressure in a closed osseofascial compartment results in microvascular compromise and possible myoneural damage. Compartment syndrome following open tibial fracture has been shown to occur with an incidence between 6 and 9% [1,2]. Following surgical decompression, recurrence is extremely rare. We report a case where both occurred.     

Chronic exertional compartment syndrome of the superficial posterior compartment: Soleus syndrome

Chronic exertional compartment syndrome (CECS) represents the second most-common cause of exertional leg pain with incidence of 27-33%. CECS of the superficial posterior compartment, or soleus syndrome, is rare and has only been discussed briefly in the literature. We discuss the management of two patients with bilateral soleus syndrome or CECS of the superficial posterior compartment.     

Lower limb compartment syndrome following coronary artery bypass surgery: a rare entity

Lower limb compartment syndrome following coronary artery bypass surgery is a rare complication that is easily overlooked. Here we report a case of lower limb compartment syndrome that was diagnosed and treated promptly in a 53-year-old man, thereby preventing a potentially lethal outcome.     

Spontaneous gluteal artery rupture resulting in compartment syndrome and sciatic neuropathy. Report of a case in Ehlers-Danlos syndrome.

Spontaneous arterial rupture is an uncommon but potentially life-threatening event. In this case spontaneous bleeding from a gluteal artery resulted in a gluteal compartment syndrome and sciatic neuropathy. Bleeding is best managed by arteriography and embolization. Similar in pathophysiology to the more common leg and forearm compartment syndromes, gluteal compartment syndromes are treated with fasciotomy. Spontaneous arterial bleeding in an extremity may be the initial symptom in patients with a rare form of Ehlers-Danlos syndrome. Additional evaluation for the presence of significant abdominal and intracranial arterial involvement is mandatory. Family members should also be evaluated for this hereditary condition.     

Compartment syndrome of the thigh as a complication of anticoagulant therapy in a patient with a left ventricular assist device (Berlin Heart)

A nontraumatic case of compartment syndrome of the thigh in a patient on anticoagulant therapy for a left ventricular assist device (LVAD) is reported. A 51-year-old man was on low-molecular-weight heparin (LMWH) anticoagulation and antiplatelet drugs for his LVAD, when he had a spontaneous-onset compartment syndrome of the posterior compartment of the left thigh, which was treated with urgent fasciotomy. Although compartment syndromes in the thigh are rare and mostly traumatic in origin, all clinicians must maintain a high degree of suspicion; moreover, although most often bleeding associated with LMWH is minor, occasionally it results in a major bleed resulting in limb-threatening conditions such as a compartment syndrome.     

Acute paediatric compartment syndrome of the hand caused by hereditary angiooedema

Compartment syndrome of the leg and forearm are well described in the literature. However, compartment syndrome of the hand is rare and in children it is even rarer. Atraumatic hand compartment syndrome has not to our knowledge been previously reported. We describe a case of an atraumatic compartment syndrome of the hand in a child who underwent an urgent fasciotomy. The child was diagnosed with hereditary angiooedema. We highlight a rare but serious complication of a hereditary disease not commonly seen by the surgical community. We hope that this report raises the awareness of this condition, thereby reducing delays in reaching a prompt diagnosis.     

Bilateral gluteal compartment syndrome after total hip arthroplasty under epidural anesthesia

The gluteal compartment syndrome is uncommon and is discussed in only a few published case reports. The simultaneous bilateral gluteal compartment syndrome is exceptionally rare and is tackled in only 4 case reports to date. We report a case of bilateral gluteal compartment syndrome after total hip arthroplasty under epidural anesthesia and discuss its management.