Illustrated operative management of spontaneous bleeding and compartment syndrome of the lower extremity in a patient with acquired hemophilia A: a case report

Review article: A comprehensive review of unusual causes of acute limb compartment syndrome

Acute limb compartment syndrome (ALCS) is a surgical emergency that can have serious consequences unless promptly diagnosed and treated, which is particularly challenging when there is an unusual cause. This is a comprehensive review of reported causes of ALCS. From 1068 included articles, we found 299 discrete causes of ALCS including toxins, infections, endocrine pathology, haematological emergencies, malignancy and iatrogenic ALCS. Familiarity with this wide range of ALCS causes may assist in early diagnosis of this limb-threatening condition.

Acute Compartment Syndrome of the Upper Extremity in Acquired Hemophilia A: A Case Report and Literature Review

CASE

Acute compartment syndrome (ACS) with acquired hemophilia A (AHA) is rare and has no established treatment strategy. A 64-year-old woman presented with a giant hematoma in the rectus abdominis. Laboratory findings included decreased hemoglobin and increased activated partial thromboplastin time. Arterial embolization was performed for hemostasis. After catheter removal, she developed severe arm pain and numbness with blistering. Fasciotomy was performed to decrease intracompartmental pressure. Laboratory investigations revealed decreased factor VIII (FVIII) activity and increased FVIII inhibitor. AHA was diagnosed and treated with immunosuppressive and FVIII inhibitor-bypassing agents.

CONCLUSIONS

Fasciotomy should be performed promptly if ACS with AHA is suspected.

Use of Recombinant Factor VIIa for Bleeding Control in Treatment of Acute Extremity Compartment Syndrome Secondary to Primary Myelofibrosis: A Case Report

CASE

A 40-year-old man was admitted to our emergency department with a painful and swollen calf. There was no history of significant trauma, and the physical examination revealed a pulseless, swollen left lower leg. Clinical history revealed a diagnosis of primary myelofibrosis, and magnetic resonance imaging showed a rupture of the gastrocnemius medial head. The diagnosis of spontaneous acute extremity compartment syndrome (AECS) secondary to myelofibrosis was established. An open fasciotomy procedure was performed, and recombinant factor VIIa treatment was applied to control bleeding. Postoperatively, fasciotomy wounds were closed with skin grafts.

CONCLUSION

AECS may develop in patients with bleeding disorders, and recombinant factor VII may help control bleeding.

Role of Antiplatelet/Anticoagulant Medications and Blood-Clotting Tests in Prediction of Traumatic Foot Compartment Syndrome

BACKGROUND

Although intracompartmental bleeding is one cause of traumatic compartment syndrome, no previous studies have defined the role of hemostatic stability in the development of traumatic compartment syndrome. Therefore, to investigate this issue, we identified the relationship between antiplatelet/anticoagulant medications and the development of traumatic foot compartment syndrome. In addition, as a possible predictor of compartment syndrome, we evaluated the utility of blood-clotting tests in the prediction of traumatic foot compartment syndrome.

METHODS

Retrospective review of patients diagnosed with isolated foot injury in our institution between 2008 and 2016 was used to identify patients who had traumatic foot compartment syndrome. Potential predictors, including medication history for antiplatelet/anticoagulant agents and blood-clotting test results, were analyzed using logistic regression analysis. The present study included 789 feet, and 29 (3.7%) had traumatic foot compartment syndrome.

RESULTS

The antiplatelet medication and the blood-clotting test results were not significantly associated with the development of traumatic foot compartment syndrome. Among other variables, damage caused by heavy objects as the injury mechanism was the only significant predictor in the development of traumatic foot compartment syndrome ( P < .05).

CONCLUSION

Our results showed that antiplatelet medication and blood-clotting tests did not predict the development of traumatic foot compartment syndrome.

LEVEL OF EVIDENCE

Level III, retrospective comparative series.