Well-Leg Compartment Syndrome After Percutaneous Nephrolithotomy in the Galdakao-Modified Supine Valdivia Position
Authors Laso-García IM, Arias-Fúnez F, Duque-Ruiz G, Díaz-Pérez D, Lorca-Álvaro J, Burgos-Revilla FJ
Received 22 April 2020
Accepted for publication 18 June 2020
Published 24 July 2020 Volume 2020:12 Pages 295—302
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Jan Colli
Inés María Laso-García, Fernando Arias-Fúnez, Gema Duque-Ruiz, David Díaz-Pérez, Javier Lorca-Álvaro, Francisco Javier Burgos-Revilla
Urology Department, Ramón y Cajal University Hospital, Alcalá University, IRYCIS, Madrid, Spain
Correspondence: Inés María Laso-García
Urology Department, Ramón y Cajal University Hospital, Alcalá University, IRYCIS, Carretera de Colmenar Km 9.100, Madrid 28029, Spain
Purpose: The objective is to present a case of well-leg compartment syndrome in the Galdakao-modified supine Valdivia position.
Results: The case of a 32-year-old male, obese (105 Kg) and a former smoker is presented. The patient was positioned in the Galdakao-modified supine Valdivia position, with lower limbs bandaged, to perform a right percutaneous nephrolithotomy. In the immediate postoperative period, significant pain was reported in the left lower limb. The limb appeared oedematous and cyanotic, although pedis pulses were preserved. Doppler ultrasound ruled out venous thrombosis. Suspecting compartment syndrome, the patient underwent a complete decompression fasciotomy of the four left leg compartments. After the surgery, values of creatine phosphokinase reached 80.000 UI/L and serum creatinine levels were 1.53 mg/dL. The patient was taken to the intensive care unit. Six months after the episode, the patient still needs rehabilitation care. The compartment syndrome is a rare complication in lithotomy position, but never described in the Galdakao-modified supine Valdivia position before, with the lower limbs in moderate flexion, and with the ipsilateral lower limb in a slightly inferior position with respect to the other. It may lead to skin necrosis, permanent neuromuscular dysfunction, myoglobinuric renal failure, amputation and even death. Therefore, this complication must be suspected and early decompression of the compartment must be performed. Risk factors include obesity, peripheral vascular disease (advanced age, hypertension, hyperlipidemia and diabetes mellitus), height, hypothermia, acidemia, BMI, male sex, combined general-spinal anesthesia, prolonged surgery time, systemic hypotension, ASA (American Society of Anesthesiologists) class, lack of operative experience, vasoconstricting drugs, important bleeding during the surgery and increased muscle bulk.
Conclusion: Compartment syndrome is a potentially life-threatening complication that may occur in the Galdakao-modified supine Valdivia position. It should be suspected in cases with risk factors and compatible clinical symptoms and signs, and treated rapidly to avoid further complications.
Keywords: well-leg compartment syndrome, percutaneous nephrolithotomy, Galdakao-modified supine Valdivia position
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