Missed positional gluteal compartment syndrome in an obese patient after foot surgery: a case report
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CASE REPORT
Open Access
Missed positional gluteal compartment syndrome in an obese patient after foot surgery: a case report Rami Khalifa1, Madison R. Craft2, Aaron J. Wey1, Ahmed M. Thabet1 and Amr Abdelgawad3*
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. Keywords: Gluteal compartment syndrome, Compartment syndrome, Buttock pain, Post-operative complication
Background Compartment syndrome in the gluteal area is a rare and often unrecognized syndrome. Trauma, vascular injury, infection, surgical positioning, and prolonged immobilization from drug or alcohol intoxication are the most common causes of gluteal compartment syndrome [1–4]. Early * Correspondence: [email protected] 3 Department of Orthopedic Surgery, Maimonides Medical Center, Maimonides Bone and Joint Center, 6010 Bay Parkway, Brooklyn, NY 11204, USA Full list of author information is available at the end of the article
recognition and treatment can help to prevent long term complications such as residual sciatic nerve problems or renal failure from rhabdomyolysis [5, 6]. A systemic review of gluteal compartment syndrome found that 50% of the gluteal compartment syndrome cases were due to prolonged immobilization after alcohol or other drugs intoxication or after long surgical interventions such as total hip or knee arthroplasty or proc
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