Lower Leg Compartment Syndrome after Appendicectomy

This case highlights the importance of a child presenting with lower leg pain and increasing analgesic requirements should have an urgent orthopaedic referral to rule out compartment syndrome as the consequences of a delayed diagnosis can be extremely severe.

Abstract

This case report acknowledges the importance of maintaining a high index of suspicion for compartment syndrome. It presents a 10-year-old boy who suffered with severe left lower leg pain that is uncontrolled with increasing analgesia after an appendicectomy. Unfortunately, a delayed referral to an orthopaedic service occurred where the patient was diagnosed with acute compartment syndrome. To date, this was the first reported case of pediatric lower leg compartment syndrome after appendicectomy.

Brief Case Description

In the hospital the patient denied any history of trauma. The patient was originally admitted under the medical team without any consultation of the orthopedic service. The patient was admitted with a presumed diagnosis of a left sided, below knee, deep venous thrombosis. Immediately following his admittance to the hospital, the boy was referred to the orthopaedic service where his leg was considered “hard” throughout all compartments with hyperesthesia of the anterior aspect of the leg. Using the (C2Dx) STIC compartment pressure monitor, the patient’s intra-compartmental pressure was measured. The data from the pressure measurement ensured a proper diagnosis of acute compartment syndrome and the patient underwent an emergent fasciotomy. Following surgery, the patient’s intra-compartmental pressure was frequently monitored to assist with recovery.

Intervention and Outcome Summary

Acute compartment syndrome is a surgical emergency, originally described by von Volkmann in 1882. Most caused by trauma, a delayed or missed diagnosis of compartment syndrome results in severe consequences such as tissue necrosis, neurological deficit, limb loss, and even death. This case is unique in the fact that they reported a new presentation of pediatric compartment syndrome while also highlighting the importance of considering compartment syndrome as a differential for unexplained increasing limb pain in a patient.

Original Publication:

Case Reports in Orthopedics

Authors:

Shane C. O’Neill, Darren F. Lui, Colm Murphy, and Patrick J. Kiely

Posted by Clinical Publication Group in Clinical Studies, Featured Articles