長時間の砕石位によりｃｒｕｓｈ　ｓｙｎｄｒｏｍｅとなった１例

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  • A Case of Crush Syndrome Associated with Prolonged Surgery in Dorsal Lithotomy Position for Recurrent Rectal Cancer.

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We report a case of Crush Syndrome associated with prolonged colorectal surgery in dorsal lithotomy position. A-66-year-old man, who underwent low anterior resection for rectal carcinoma in 1995, had a locally recurrence 3.5 years after the first operation. The recurrent tumor was resected by Miles operation, which lasted 14 hours 33 minutes with 4, 390 ml of blood loss. The patient was fixed on the operating table in lithotomy position from the start of operation, and 11 hours after, his hip and knee joints were repositioned and strongly flexed for the peritoneal approach. One hour after repositioning, he had a hypotension and tachycardia. On the 1st postoperative day, his legs were found to look purple. Acute renal failure developed with the elevation of serum creatinine and hyperkalemia. Continuous hemodiafiltration (CHDF) was initiated for 22 days. His renal function recovered, however, his legs motor function remained impaired. This case suggested that the duration of lithotomy position should be minimized.

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