Acute compartment syndrome as the initial manifestation of chronic-phase chronic myeloid leukemia: a case report and review of the literature

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.

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.

Acute compartment syndrome resultant from alcohol abuse

Acute compartment syndrome (ACS) is defined as a severe rise in pressure within a fascial compartment thereby leading to impaired microvascular perfusion of the limb. Therefore, ACS is a surgical emergency and if not treated immediately, permanent neurovascular and muscular compromise can ensue. When compartment syndrome is suspected, clinical recognition and timely assessment of the limb is essential to preventing limb ischemia. The classic cause of ACS is trauma; however, coagulopathies have been known to incite these events. Hemorrhage into a compartment can cause ACS but is rare in the literature. Here we present a case of thrombophilia resulting from pathological liver disease, leading to ACS that ultimately led to limb exsanguination. Education on early recognition of liver disease as an indirect underlying cause of ACS is imperative in order to prevent the dangerous sequelae that follow ACS.

Two cases of unidentified acute compartment syndrome

Acute compartment syndrome (ACS) is a surgical emergency that requires urgent fasciotomy to prevent irreversible sequelae. We report two cases of unidentified ACS, which did not result from traumatic injuries such as fractures or crush injury, iatrogenic injury or diseases such as haematological malignancies. Both patients complained of severe pain and swelling of their extremity. No bite marks, blisters or skin necrosis was noted. They also complained of marked symptoms of third cranial nerve injury, including divergent squint and diplopia. The diagnosis of ACS was made following continuous intracompartmental pressure measurement, and both patients underwent urgent fasciotomy with partial incision. Considering the season and location of the injuries, together with the rapid progression of signs and symptoms that included thrombocytopaenia, acute renal failure, rhabdomyolysis and especially that of third cranial nerve injury, we postulate that these two cases may have developed following mamushi (Gloydiusblomhoffii) bites.