Lower leg compartment syndrome following laparoscopic uterine malignancy surgery for uterine cancer complicated by rheumatoid arthritis: a case report and literature review

Title Author DOI Article Type Special Issue Volume Issue Search - Views 2904 - Dowloads 192 Lower leg compartment syndrome following laparoscopic uterine malignancy surgery for uterine cancer complicated by rheumatoid arthritis: a case report and literature review - Hanako Sato1 - Yasushi Kotani1,*, - Shiro Takamatsu2 - Mamiko Ohta1 - Reona Shiro1 - Kiko Yamamoto1 - Kosuke Murakami1 - Noriomi Matsumura1 1Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Ohno-Higashi, 577-8502 Osaka-Sayama, Japan 2Department of Obstetrics and Gynecology, Kyoto Graduate School of Medicine, Kyoto University, Yoshidakonoecho, 606-8501 Kyoto, Japan DOI: 10.31083/j.ejgo.2021.03.2296 Vol.42,Issue 3,June 2021 pp.590-594 Submitted: 01 November 2020 Accepted: 22 January 2021 Published: 15 June 2021 (This article belongs to the Special Issue Minimally Invasive Surgery in Gynecologic Oncology) *Corresponding Author(s): Yasushi Kotani E-mail: [email protected] Background: Compartment syndrome is a condition in which an increased internal pressure in the upper/lower leg compartment results in circulatory disturbance causing muscle and nerve dysfunction. There have been five case reports of compartment syndrome following gynecologic laparoscopic surgery. We present this rare case herein with a review of the related literature. Case: The patient was a 44-year-old woman. She underwent laparoscopic modified radical hysterectomy for uterine cancer. During surgery, she wore elastic stockings from her toes to her knees. She also had intermittent pneumatic compression of the thighs and lower legs with the head down at 15 degrees. The operative time was 6 h and 49 min. She was diagnosed with compartment syndrome, and a decompression incision was indicated. Conclusion: After experiencing this case, we use the open leg position, releasing the high pelvic position for 10 min every 3 h, during which the nurse should decompress the foot. Compartment syndrome; Laparoscopic surgery; Endometrial cancer Hanako Sato,Yasushi Kotani,Shiro Takamatsu,Mamiko Ohta,Reona Shiro,Kiko Yamamoto,Kosuke Murakami,Noriomi Matsumura. Lower leg compartment syndrome following laparoscopic uterine malignancy surgery for uterine cancer complicated by rheumatoid arthritis: a case report and literature review. European Journal of Gynaecological Oncology. 2021. 42(3);590-594. [1] Von Volkman R. Veilletzungen und Krankenheiten der Berwegungsorgane. In Von Pithe F, Billroth T. (eds.) Handbuch der All- gemeinen und Speciellen Chirurgs. Band 2, Abteilung 2, Halfte 1 (pp. 234–920). Stuttgart: Enke. 1882. (In Germany) [2] Leff RG, Shapiro SR. Lower extremity complications of the position. Journal of Urology. 1979; 122, 138–139. [3] Heppenstall B, Tan V. Well-leg compartment syndrome. Lancet. 1999; 354: 970. [4] Halliwill JR, Hewitt SA, Joyner MJ, Warner MA. Effect of various lithotomy positions on lower-extremity blood pressure. Anesthesiology. 1998; 89: 1373–1376. [5] Bauer ECA, Koch N, Erichsen CJ, Juettner T, Rein D, Janni W, et al. Survey of compartment syndrome of the lower extremity after gynecological operations. Langenbeck’S Archives of Surgery. 2014; 399: 343–348. [6] Harris KA, Provan JL. Hazards of epidural anesthesia in patients with previous vascular grafts. Canadian Journal of Surgery. Journal Canadien de Chirurgie. 1987; 30: 124–125. [7] Piriou V, Feugier P, Granger S, Gueugniaud PY. Ischaemia of the lower limbs: anaesthesia and intensive care. Annales Françaises d’Anesthésie et de Réanimation. 2004; 23: 1160–1117. (In French) [8] Nishino M, Okano M, Kawada J, Kim Y, Yamada M, Tsujinaka T. Well-leg compartment syndrome after laparoscopic low anterior resection for lower rectal cancer in the lithotomy position: a case report. Asian Journal of Endoscopic Surgery. 2018; 11: 53–55. [9] Tomassetti C, Meuleman C, Vanacker B, D’Hooghe T. Lower limb compartment syndrome as a complication of laparoscopic laser surgery for severe endometriosis. Fertility and Sterility. 2009; 92: 2038.e9–2038.e12. [10] Lawrenz B, Kraemer B, Wallwiener D, Witte M, Fehm T, Becker S. Lower extremity compartment syndrome after laparoscopic radical hysterectomy: brief report of an unusual complication of laparoscopic positioning requirements. Journal of Minimally Invasive Gynecology. 2011; 18: 531–533. [11] Boesgaard-Kjer DH, Boesgaard-Kjer D, Kjer JJ. Well-leg compartment syndrome after gynecological laparoscopic surgery. Acta Obstetricia et Gynecologica Scandinavica. 2013; 92: 598–600. [12] Stornelli N, Wydra FB, Mitchell JJ, Stahel PF, Fabbri S. The dangers of lithotomy positioning in the operating room: case report of bilateral lower extremity compartment syndrome after a 90-minutes surgical procedure. Patient Safety in Surgery. 2016; 10: 18. [13] Rao MM, Jayne D. Lower limb compartment syndrome following laparoscopic colorectal surgery: a review. Colorectal Disease. 2011; 13: 494–499. [14] Cohen SA, Hurt WG. Compartment syndrome associated with lithotomy position and intermittent compression stockings. Obstetrics and Gynecology. 2001; 97: 832–833. [15] Yanazume S, Yanazume Y, Iwamoto I, Tsuji T, Yoshinaga M, Douchi T. Severe leg compartment syndrome associated with dorsal lithotomy position during radical hysterectomy. The Journal of Obstetrics and Gynaecology Research. 2006; 32: 610–612. [16] Nakamura K, Aoki H, Hirakawa T, Murata T, Kanuma T, Minegishi T. Compartment syndrome with thrombosis of common iliac artery after gynecologic surgery. Obstetrics and Gynecology. 2008; 112: 486–488. [17] Carlson JA, Chen K. Cutaneous vasculitis update: small vessel neutrophilic vasculitis syndromes. the American Journal of Dermatopathology. 2006; 28: 486–506. [18] Shiota M, Kotani Y, Umemoto M, Tobiume T, Tsuritani M, Shimaoka M, et al. Deep-vein thrombosis is associated with large uterine fibroids. the Tohoku Journal of Experimental Medicine. 2011; 224: 87–89. [19] Shiota M, Kotani Y, Umemoto M, Tobiume T, Hoshiai H. Incidental detection of breast apocrine carcinoma via endometrial cytology. the Tohoku Journal of Experimental Medicine. 2011; 225: 235–237. [20] Verdolin MH, Toth AS, Schroeder R. Bilateral lower extremity compartment syndromes following prolonged surgery in the low lithotomy position with serial compression stockings. Anesthesiology. 2000; 92: 1189–1191. [21] Lachmann EA, Rook JL, Tunkel R, Nagler W. Complications associated with intermittent pneumatic compression. Archives of Physical Medicine and Rehabilitation. 1992; 73: 482–485. [22] Turnbull D, Mills GH. Compartment syndrome associated with the Lloyd Davies position. Three case reports and review of the literature. Anaesthesia. 2001; 56: 980–987. [23] Beraldo S, Dodds SR. Lower Limb Acute Compartment Syndrome after Colorectal Surgery in Prolonged Lithotomy Position. Diseases of the Colon & Rectum. 2006; 49: 1772–1780. Top