An unusual presentation of compartment syndrome following deep venous thrombosis
DOI:
https://doi.org/10.18203/2320-6012.ijrms20262199Keywords:
DVT, Compartment syndrome, Fasciotomy, VACAbstract
A young female in her early 30s was admitted in medicine department of our hospital for swelling in left lower limb with decreased urine output. She had history of lower segment caesarean section (LSCS) done for obstructed labour and was bedridden. Venous color Doppler was done which was suggestive of deep vein thrombosis (DVT) in left lower limb. Surgery reference was sent for increased left lower limb swelling. On examination there was compartment syndrome in left lower limb for which urgent fasciotomy was done in emergency setting and patient was transferred under surgery department. Later debridement was done for unhealthy muscles and multiple cycles of VAC were applied when wound was healthy and granulated. In between VAC dressings, hypertonic saline dressings were also done to decrease muscle oedema. Patient was kept on LMWH injection. Patient was discharged on Tab Dabigatran after approximately 1 month of admission with stable vitals and edematous left lower limb. After 4 cycles of VAC application patient was planned for STSG. Debridement and STSG from right thigh to cover raw area along with assistance from plastic surgery department. Patient was vitally stable postoperatively with minimal soakage was done of right thigh donor area. Postoperatively dressing was removed which showed healthy graft uptake with no collection underneath it.
References
Waheed SM, Kudaravalli P, Hotwagner DT. Deep Venous Thrombosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2023.
Wang H, Pei H, Ding W, Yang D, Ma L. Risk factors of postoperative deep vein thrombosis (DVT) under low molecular weight heparin (LMWH) prophylaxis in patients with thoracolumbar fractures caused by high-energy injuries. J Thrombol Thrombol. 2021;51:397-404.
Huang Y, Ge H, Wang X, Zhang X. Association Between Blood Lipid Levels and Lower Extremity Deep Venous Thrombosis: A Population-Based Cohort Study. Clin Appl Thromb Hemost. 2022;28:10760296221121282.
Jain N, Avanthika C, Singh A, Jhaveri S, De la Hoz I, Hassen G, et al. Deep Vein Thrombosis in Intravenous Drug Users: An Invisible Global Health Burden. Cureus. 2021;13(10):e18457.
Stubbs MJ, Mouyis M, Thomas M. Deep vein thrombosis. BMJ. 2018;360:k351.
Schmidt AH. Acute compartment syndrome. Orthop Clin North Am. 2016;47:517-52.
Newman PA, Deo S. Non-traumatic compartment syndrome secondary to deep vein thrombosis and anticoagulation. BMJ Case Rep. 2014;2014:bcr2013201689.
Borow MHJ. Goldson. Prevention of postoperative deep venous thrombosis and pulmonary emboli with combined modalities. Am Surg. 1983;49(11):599-605.
Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107:I9-16.
FA Anderson Jr, HB Wheeler, RJ Goldberg, DW Hosmer, A Forcier. The prevalence of risk factors for venous thromboembolism among hospital patients. Arch Int Med. 1992;152(8):1660-4.
Kim JY, Khavanin N, Rambachan A, McCarthy RJ, Mlodinow AS, De Oliveria GS Jr, et al. Surgical duration and risk of venous thromboembolism. JAMA Surg. 2015;150(2):110-7.
Prandoni P, Noventa F, Ghirarduzzi A, Pengo V, Bernardi E, Pesavento R, et al. The risk of recurrent venous thromboembolism after discontinuing anticoagulation in patients with acute proximal deep vein thrombosis or pulmonary embolism. A prospective cohort study in 1,626 patients. Haematologica. 2007;92(2):199-205.
Pengo V, Lensing AW, Prins MH, Marchiori A, Davidson BL, Tiozzo F, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004;350(22):2257-64.
Wilson S, Chen X, Cronin M, Dengler N, Enker P, Krauss ES, et al. Thrombosis prophylaxis in surgical patients using the Caprini Risk Score. Curr Probl Surg. 2022;59(11):101221.
Silverstein MD, Heit JA, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ III. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med. 1998;158(6):585-93.
Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, et al. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol. 2014;34(11):2363-71.
Huang W, Goldberg RJ, Anderson FA, Kiefe CI, Spencer FA. Secular trends in occurrence of acute venous thromboembolism: the Worcester VTE study (1985-2009). Am J Med. 2014;127(9):829-39.e5.
Qaseem A, Snow V, Barry P, Hornbake ER, Rodnick JE, Tobolic T, et al. Current diagnosis of venous thromboembolism in primary care: a clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Ann Fam Med. 2007;5(1):57-62.
Qvarfordt P, Eklöf B, Ohlin P. Intramuscular pressure in the lower leg in deep vein thrombosis and phlegmasia cerulae dolens. Ann Surg. 1983;197:450-3.
Mesfin A, Lum YW, Nayfeh T, Mears SC. Compartment syndrome in patients with massive venous thrombosis after inferior vena cava filter placement. Orthopedics. 2011;34(3):229.
Dowen D, Aldridge S, O'Brien S. Compartment syndrome after low molecular weight heparin following lower limb blunt trauma: lessons for outpatient deep vein thrombosis protocols. BMJ Case Rep. 2009;2009:bcr01.
Hope MJ, McQueen MM. Acute compartment syndrome in the absence of fracture. J Orthop Trauma. 2004;18:220-4.
Elliott KG, Johnstone AJ. Diagnosing acute compartment syndrome. J Bone Joint Surg Br. 2003;85:625-32.
McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk? J Bone Joint Surg Br. 2000;82:200-3.
Beraldo S, Dodds SR. Lower limb acute compartment syndrome after colorectal surgery in prolonged lithotomy position. Dis Colon Rectum. 2006;49:1772-80.
Modi A, Amin H, Salzman M, Morgan F. Acute compartment syndrome caused by uncontrolled hypothyroidism. Am J Emerg Med. 2017;35:937.
Pamoukian VN, Rubino F, Iraci JC. Review and case report of idiopathic lower extremity compartment syndrome and its treatment in diabetic patients. Diabetes Metab. 200;6:489-92.
Mahdi H, Gough S, Gill KK, Mahon B. Acute spontaneous compartment syndrome in recent onset type 1 diabetes. Emerg Med J. 2007;24:507-8.
Wang J, Duan Q, Sun X, Mou X, Song B, Yuan H. Acute compartment syndrome of the leg due to infection following an insect bite: a case report. Medicine. 2018;97:11613.
Griffiths D, Jones DH. Spontaneous compartment syndrome in a patient on long-term anticoagulation. J Hand Surg. 1993;18:41-42.
Dalton DM, Munigangaiah S, Subramaniam T, McCabe JP: Acute bilateral spontaneous forearm compartment syndrome. Hand Surg. 2014;19:99-102.
Newman PA, Deo S. Non-traumatic compartment syndrome secondary to deep vein thrombosis and anticoagulation. BMJ Case Rep. 2014;2014:bcr2013201689.
Schimelpfenig S, Liddell T, Page E. A case of acute compartment syndrome of the thigh associated with repetitive athletic trauma. S D Med. 2016;69:553-5.
VanFleet TA, Raab MG, Watson MD. Popliteal vein thrombosis causing compartment syndrome: a case report. Clin Orthop Relat Res. 1996;325:190-3.
Kuklo TR, Tis JE, Moores LK, Schaefer RA. Fatal rhabdomyolysis with bilateral gluteal, thigh, and leg compartment syndrome after the Army Physical Fitness Test: a case report. Am J Sports Med. 2000;28:112-6.
Lobastov K, Barinov V, Schastlivtsev I, Laberko L, Rodoman G, Boyarintsev V. Validation of the Caprini risk assessment model for venous thromboembolism in high-risk surgical patients in the background of standard prophylaxis. J Vasc Surg Venous Lymphat Disord. 2016;4(2):153-60.
Oh DK, Song JM, Park DW, Oh SY, Ryu JS, Lee J, et al. The effect of a multidisciplinary team on the implementation rates of major diagnostic and therapeutic procedures of chronic thromboembolic pulmonary hypertension. Heart Lung. 2019;48(1):28-33.
Zaki HA, Albaroudi B, Shaban EE, Elgassim M, Almarri ND, Basharat K, et al. Deep venous thrombosis (DVT) diagnostics: gleaning insights from point-of-care ultrasound (PoCUS) techniques in emergencies: a systematic review and meta-analysis. Ultrasound J. 2024;16(1):37.
Ho VB, van Geertruyden PH, Yucel EK, Rybicki FJ, Baum RA, Desjardins B, et al. ACR Appropriateness Criteria(®) on suspected lower extremity deep vein thrombosis. Am J Obs Gyn. 1994;171:713-21.
Downloads
Published
How to Cite
Issue
Section
