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Compartment Syndrome of the Lower Leg After Surgery in the Modified Lithotomy Position: Report of Seven Cases

  • Published:
Diseases of the Colon & Rectum

Purpose

Acute compartment syndrome is known to develop after trauma or after postischemic revascularization. It also can occur when a patient has been lying in the lithotomy position during prolonged surgery. Methods were searched for the prevention of this iatrogenic complication after a series of seven patients who developed compartment syndrome after surgery at our hospital.

Methods

A series of seven consecutive patients who developed compartment syndrome of the lower leg(s) after abdominoperineal surgical procedures from 1997 to 2002 is presented and so are the lessons learned to prevent this problem.

Results

When comparing our experiences with data from literature, the seven patients had the usual risk factors for development of a compartment syndrome: lengthy procedure (>5 hours); decreased perfusion of the lower leg because of Trendelenburg positioning combined with the lithotomy position; and external compression of the lower legs (because of positioning, stirrups, or antiembolism stockings). Measures have been taken to prevent compartment syndrome from developing after prolonged surgery in the lithotomy position. This complication has not occurred again after the introduction of these measures two years ago.

Conclusions

Acute compartment syndrome can be prevented if adequate measures are taken, but after lengthy surgery, maximum alertness for emerging acute compartment syndrome remains indicated. Early diagnosis and treatment by four-compartment fasciotomy is still the only way to prevent irreversible damage.

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Authors and Affiliations

  1. Department of General Surgery, University Medical Center, Utrecht, The Netherlands

    Eelco B. Wassenaar M.D., Johan G. H. van den Brand M.D., Ph.D. & Christian van der Werken M.D., Ph.D.

  2. Department of General Surgery and Traumatology, Medical Center Alkmaar, Alkmaar, The Netherlands

    Johan G. H. van den Brand M.D., Ph.D.

  3. Medical Center Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands

    Johan G. H. van den Brand M.D., Ph.D.

Authors
  1. Eelco B. Wassenaar M.D.
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  2. Johan G. H. van den Brand M.D., Ph.D.
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  3. Christian van der Werken M.D., Ph.D.
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Corresponding author

Correspondence to Johan G. H. van den Brand M.D., Ph.D..

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Wassenaar, E.B., van den Brand, J.G.H. & van der Werken, C. Compartment Syndrome of the Lower Leg After Surgery in the Modified Lithotomy Position: Report of Seven Cases. Dis Colon Rectum 49, 1449–1453 (2006). https://doi.org/10.1007/s10350-006-0688-x

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  • DOI: https://doi.org/10.1007/s10350-006-0688-x

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