A Case of well leg compartment syndrome after Laparoscopic Sacrocolpopexy

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  • Shibata Mayuko
    Department of Obetetrics and Gynecology, Gifu Munisipal Hospital
  • Yamamoto Kazushige
    Department of Obetetrics and Gynecology, Gifu Munisipal Hospital
  • Tanigaki Keiko
    Department of Obetetrics and Gynecology, Gifu Munisipal Hospital
  • Yin Limei
    Department of Obetetrics and Gynecology, Gifu Munisipal Hospital
  • Toyoki Hiroshi
    Department of Obetetrics and Gynecology, Gifu Munisipal Hospital

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Other Title
  • 腹腔鏡下仙骨腟固定術（LSC）術後に下肢コンパートメント症候群を生じた1 例

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<p>Well leg compartment syndrome (WLCS) is a complication following prolonged gynecologic laparoscopic surgery. Here, we report a case of WLCS after laparoscopic sacrocolpopexy (LSC). Patient: Seventy-nine-year-old woman, 3 pregnancies, 2 births, BMI of 19. 8. History of present illness: Uterine prolapse since 74 years; came to our department after experiencing frequent urination and a residual urine sensation. Diagnosis of stage 3 uterine prolapse, stage 2 cystocele, and CIN1. She underwent LSC, hysterectomy, and bilateral adnexectomy. The surgery took 5 hours and 20 minutes. Patient was placed in the lithotomy position and wore elastic stockings and an intermittent pneumatic compression device. Immediately after waking from anesthesia, pain appeared in the left lower extremity, which then became severe and left lower leg swelling was observed, so the patient was referred to an orthopedic surgeon. Contrast-enhanced computed tomography revealed intramuscular hematoma in the left soleus muscle, with CK of 163 U/L and intramuscular compartment pressure of 10–20mmHg, leading to an WLCS diagnosis. Since there was no motor or sensory paralysis and the muscle compartment pressure was under 50mmHg, conservative follow-up with cooling and rest was decided. Rehabilitation of the right foot began the day after the operation, and the CK level rose to 3,415 U/L on postoperative day 3, before decreasing. Patient could walk with a cane on the 20th postoperative day, and was discharged 3 days later. Discussion: The risk factors for WLCS include prolonged surgery, lithotomy position, old age, and wearing elastic stockings. During long operations, the risk can be reduced by releasing the insufflation, pelvic elevation, and lithotomy position every three hours, and massaging the legs.</p>

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