Modified Approach for Rapid Decompression of Gluteal Compartment Syndrome: A Case Series
Munir Patel, Nicole Ilonzo, Michael Dudkiewicz, John Lantis.
Mount Sinai - St. Luke's - West, New York, NY, USA.
Objective(s): We plan to present a 2 patient case series of rare gluteal compartment syndrome and the subsequent surgical decompression using a novel modified Kocher-Langenbeck approach.
Methods: Our first patient is a 36M with a history of hepatitis B and ureteropelvic junction obstruction who underwent a right sided robotic pyeloplasty, during which he was in left lateral decubitus position for over 5 hours. Post-operatively, patient was complaining of pain out of proportion to exam in the left gluteal and tensor fasciae latae (TFL) region. CT scan showed significantly enlarged unilateral gluteal compartments. CPK was trended and increased from 34,000 to 264,000 within 24 hours, and gluteal compartment pressures at that time were 40 mmHg. Patient was taken to the OR and decompressed using the modified incision.
Our second patient is a 39M with history of opiate, testosterone, human growth hormone, and creatine use who had several falls while in the shower. He presented to the ED in acute kidney injury (AKI). He was noted to have ecchymosis on the left leg and gluteal region accompanied by foot numbness andweakness. CT scan showed unilateral pelvic musculature edema, CPK was 244,000, and Stryker needle compartment pressures were 34 mmHg and 40
mmHg throughout the gluteal compartment. Patient was taken back to the OR and the modified incision was used to successfully decompress all three gluteal compartments.
Both cases used the modified incision that started at the posterior superior iliac spine, went along the edge of iliac crest, and started curving caudally around the midpoint of the iliotibial tract to at the greater trochanter. This allowed access to all three gluteal compartments without significant flap formation or dissection, and resulted in a single incision with subsequent tension-free closure in our patients.
Results: Both fasciotomy sites were able to be closed primarily within the first week after surgery (POD 7 and POD 4 respectively). Both patients were able to ambulate following closure without deficit.
Conclusions: Gluteal compartment syndrome is a rare entity. Surgeons who have made this diagnosis have used various techniques in approaching the decompression of all three gluteal compartments. Our novel method leads to rapid decompression of all three compartments with a single incision and allows patients a
quick return to baseline functional status.
Back to 2017 ePoster Competition